Basic Information
| Provider Information | |||||||||
| NPI: | 1760438642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TONKIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4514E CROMWELL ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658022551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175531080 | ||||||||
| FaxNumber: | 8884725145 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 W SUNSET RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891131981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025141411 | ||||||||
| FaxNumber: | 7145141413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2007017247 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 15564 | NV | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LA0401X | 2007017247 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LA0401X | 15564 | NV | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LP2900X | 15564 | NV | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 15564 | NV | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 15564 | NV | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0014X | 2007017247 | MO | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 500025928 | 05 | MO | MEDICAID | 1760438642 | 05 | NV | MEDICAID |