Healthcare Provider Details

I. General information

NPI: 1245235456
Provider Name (Legal Business Name): RICHARD GRAY TOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 DOCTORS DR
WEST PLAINS MO
65775-4754
US

IV. Provider business mailing address

1410 DOCTORS DR
WEST PLAINS MO
65775-4754
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-2225
  • Fax: 417-256-2373
Mailing address:
  • Phone: 417-256-2225
  • Fax: 417-256-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD 102941
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: