Basic Information
Provider Information
NPI: 1922177583
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOMPKINS
FirstName: DAREN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1308 PALUXY RD STE A
Address2:  
City: GRANBURY
State: TX
PostalCode: 760485689
CountryCode: US
TelephoneNumber: 8174083197
FaxNumber: 8175793926
Practice Location
Address1: 601 FALL CREEK HWY
Address2:  
City: GRANBURY
State: TX
PostalCode: 760497960
CountryCode: US
TelephoneNumber: 8173263900
FaxNumber: 8175788903
Other Information
ProviderEnumerationDate: 11/07/2006
LastUpdateDate: 09/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XS0386TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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