Healthcare Provider Details

I. General information

NPI: 1023257169
Provider Name (Legal Business Name): MATTHEW THOMPSON, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 RICHMOND AVE SUITE 310
HOUSTON TX
77098-3104
US

IV. Provider business mailing address

2990 RICHMOND AVE SUITE 310
HOUSTON TX
77098-3104
US

V. Phone/Fax

Practice location:
  • Phone: 713-385-2112
  • Fax: 281-822-0887
Mailing address:
  • Phone: 713-385-2112
  • Fax: 281-822-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberK7220
License Number StateTX

VIII. Authorized Official

Name: MATTHEW M THOMPSON
Title or Position: OWNER
Credential: MD
Phone: 713-385-2112