Provider Demographics
NPI:1104941475
Name:TOMPKINS, RICHARD KELSEY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KELSEY
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15407 14TH DR SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8467
Mailing Address - Country:US
Mailing Address - Phone:425-316-3799
Mailing Address - Fax:
Practice Address - Street 1:15407 14TH DR SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-8467
Practice Address - Country:US
Practice Address - Phone:425-316-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABT7882017OtherDEA
WAGAB40259Medicare ID - Type Unspecified
WABT7882017OtherDEA