Individual
DREW RAY THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1651 W. ROSEDALE, SUITE 200, FORT WORTH, TX 76104-7437
(817) 335-4316
(817) 332-4465
Mailing address
P.O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 332-4465
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TEMPORARY PENDING
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285932401
—
TX
01
—
P00975532
RAILROAD MEDICARE
TX
Enumeration date
07/06/2011
Last updated
01/16/2012
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