Healthcare Provider Details

I. General information

NPI: 1063441236
Provider Name (Legal Business Name): THOMAS GERALD DEPUYDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12707 120TH AVE NE SUITE 203
KIRKLAND WA
98034-7500
US

IV. Provider business mailing address

12707 120TH AVE NE SUITE 203
KIRKLAND WA
98034-7500
US

V. Phone/Fax

Practice location:
  • Phone: 425-820-1221
  • Fax: 425-821-9362
Mailing address:
  • Phone: 425-820-1221
  • Fax: 425-821-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMD00017432
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD00017432
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD00017432
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD00017432
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00017432
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberMD00017432
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: