Basic Information
| Provider Information | |||||||||
| NPI: | 1942390810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMKINS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 6TH AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534031444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 311 S L ST | ||||||||
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| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984053720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534031444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | MD00035172 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 207R00000X | MD00035182 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2080C0008X | MD00035182 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics | 2080P0204X | MD00035182 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 208000000X | MD00035182 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 115903 | 01 | WA | L & I | OTHER | 911019392 | 01 | COMMERCIAL | OTHER | TO4710 | 01 | WA | REGENCE | OTHER | 22554 | 01 | GROUP HEALTH | OTHER | 8209793 | 05 | WA | MEDICAID | 8209793 | 01 | WA | CHPW | OTHER |