Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD00023201 | WA |
NPI | 1073596078 |
---|---|
Provider Name | Dr. Robert C Tomford |
First Address | Olympia, WA 98506-5197 |
Second Address | Olympia, WA 98506-5195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1008259 | (05) | WA |
A08631 | (02) |