Provider Demographics
NPI:1306892559
Name:TOMPKINS, RODERICK J JR (MD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:J
Last Name:TOMPKINS
Suffix:JR
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE 440
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-329-2888
Practice Address - Fax:606-329-2890
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32875208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328750Medicaid
OH2026757Medicaid
WV3810005113Medicaid
OH2026757Medicaid
WV3810005113Medicaid