Healthcare Provider Details

I. General information

NPI: 1912810532
Provider Name (Legal Business Name): MR. DAVID CHARLES THOMPSON SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4603 S J ST
TACOMA WA
98408-3728
US

IV. Provider business mailing address

4603 S J ST
TACOMA WA
98408-3728
US

V. Phone/Fax

Practice location:
  • Phone: 253-317-7206
  • Fax:
Mailing address:
  • Phone: 253-317-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: