Healthcare Provider Details

I. General information

NPI: 1255418265
Provider Name (Legal Business Name): STACY D TOMPKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 301
GRESHAM OR
97030-3725
US

IV. Provider business mailing address

1793 13TH ST SE
SALEM OR
97302-2541
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-8385
  • Fax: 503-362-8435
Mailing address:
  • Phone: 503-362-8385
  • Fax: 503-362-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD224105
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA52958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: