Provider Demographics
NPI:1063441236
Name:DEPUYDT, THOMAS GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERALD
Last Name:DEPUYDT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12707 120TH AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7500
Mailing Address - Country:US
Mailing Address - Phone:425-820-1221
Mailing Address - Fax:425-821-9362
Practice Address - Street 1:12707 120TH AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7500
Practice Address - Country:US
Practice Address - Phone:425-820-1221
Practice Address - Fax:425-821-9362
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00017432204C00000X, 207QA0505X, 207QS0010X, 2080S0010X, 2081S0010X, 2083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Not Answered2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Not Answered2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA04372Medicare UPIN