Healthcare Provider Details

I. General information

NPI: 1063733293
Provider Name (Legal Business Name): TOBIN D RUMMEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 STOLLER RD
TROUT LAKE WA
98650-9712
US

IV. Provider business mailing address

4 STOLLER RD
TROUT LAKE WA
98650-9712
US

V. Phone/Fax

Practice location:
  • Phone: 509-395-2061
  • Fax:
Mailing address:
  • Phone: 509-395-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPG151477
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: