Healthcare Provider Details

I. General information

NPI: 1538354766
Provider Name (Legal Business Name): BRYAN J TOMPKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 5TH AVE
SPOKANE WA
99204-2901
US

IV. Provider business mailing address

SHRINERS HOSPITALS FOR CHILDREN SPOKANE DEPT 5046
LOS ANGELES CA
90084-5046
US

V. Phone/Fax

Practice location:
  • Phone: 509-623-0428
  • Fax: 509-623-0415
Mailing address:
  • Phone: 813-281-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD00048099
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: