Healthcare Provider Details

I. General information

NPI: 1134666548
Provider Name (Legal Business Name): IAN M THOMPSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 BABCOCK RD STE 203
SAN ANTONIO TX
78229-4894
US

IV. Provider business mailing address

2833 BABCOCK RD STE 203
SAN ANTONIO TX
78229-4894
US

V. Phone/Fax

Practice location:
  • Phone: 210-960-0081
  • Fax:
Mailing address:
  • Phone: 210-960-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: IAN M THOMPSON JR.
Title or Position: OWNER
Credential: MD
Phone: 210-960-0081