Healthcare Provider Details

I. General information

NPI: 1366818288
Provider Name (Legal Business Name): JOHN THURMOND, M.D. AND ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 KATHERINE CT
ARLINGTON TX
76016-4039
US

IV. Provider business mailing address

4621 S COOPER ST STE 131 #810
ARLINGTON TX
76017-5815
US

V. Phone/Fax

Practice location:
  • Phone: 817-368-7239
  • Fax: 830-632-6568
Mailing address:
  • Phone: 817-368-7239
  • Fax: 830-632-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL1218
License Number StateTX

VIII. Authorized Official

Name: JOHN IRA THURMOND III
Title or Position: OWNER/MD
Credential: MD
Phone: 817-368-7239