Healthcare Provider Details

I. General information

NPI: 1134337611
Provider Name (Legal Business Name): ALI MANNING THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARTIN LUTHER KING JR WAY GROUP HEALTH TACOMA MEDICAL CENTER
TACOMA WA
98405
US

IV. Provider business mailing address

209 MARTIN LUTHER KING JR WAY TACOMA MEDICAL CENTER
TACOMA WA
98405-4267
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3300
  • Fax:
Mailing address:
  • Phone: 253-596-3300
  • Fax: 253-596-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00048437
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD00048437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: