Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1245 | CO |
Y | 103T00000X | Psychologist | 1245 | CO |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 5977 | CO |
NPI | 1477658763 |
---|---|
Provider Name | Dr. Dale Saul Tompkins |
First Address | Grand Junction, CO 81501 |
Second Address | Grand Junction, CO 81501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 05/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680010720 | MEDICARE RAILROAD (01) | CO |
C89316 | (02) | CO |