MEDICARE: DR. PAUL DAVID THOMPSON M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	R5H02	MO
2	207Q00000X	Family Medicine Physician	M8385	TX

General Provider Information

NPI Number	:	1548200785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DAVID THOMPSON M. D.

Provider Business Mailing Address
First Line	:	5408 BIRCHMAN AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5111
Country	:	US
Telephone Number	:	817-731-1952
Fax Number	:	817-731-1955

Provider Business Practice Location Address
First Line	:	5408 BIRCHMAN AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5111
Country	:	US
Telephone Number	:	817-731-1952
Fax Number	:	817-731-1955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/13/2021

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