Provider Demographics
NPI:1003841610
Name:TOMPKINS, RHETT HUME (PA C)
Entity Type:Individual
Prefix:
First Name:RHETT
Middle Name:HUME
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 TOTEM TRL
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2241
Mailing Address - Country:US
Mailing Address - Phone:952-543-0729
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-3757
Practice Address - Country:US
Practice Address - Phone:651-528-8183
Practice Address - Fax:651-528-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P29207Medicare UPIN