Healthcare Provider Details

I. General information

NPI: 1477887313
Provider Name (Legal Business Name): J. DAVID THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W STATE HIGHWAY 114 SUITE 110
GRAPEVINE TX
76051-8649
US

IV. Provider business mailing address

2020 W STATE HIGHWAY 114 SUITE 110
GRAPEVINE TX
76051-8649
US

V. Phone/Fax

Practice location:
  • Phone: 817-310-0810
  • Fax: 817-812-3525
Mailing address:
  • Phone: 817-310-0810
  • Fax: 817-812-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19257
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number19257
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: