MEDICARE: DR. DALE SAUL TOMPKINS PHD CACIII SAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1245	CO
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	5977	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680010720	OTHER	CO	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1477658763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE SAUL TOMPKINS PHD CACIII SAP

Provider Business Mailing Address
First Line	:	1170 COLORADO AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501
Country	:	US
Telephone Number	:	970-241-2948
Fax Number	:	970-242-4219

Provider Business Practice Location Address
First Line	:	1170 COLORADO AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501
Country	:	US
Telephone Number	:	970-241-2948
Fax Number	:	970-242-4219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	04/05/2013

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