Provider Demographics
NPI:1073596078
Name:TOMFORD, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:TOMFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 LILLY RD NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5197
Mailing Address - Country:US
Mailing Address - Phone:360-413-8121
Mailing Address - Fax:360-413-8865
Practice Address - Street 1:500 LILLY RD NE
Practice Address - Street 2:SUITE 203
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5195
Practice Address - Country:US
Practice Address - Phone:360-413-8121
Practice Address - Fax:360-413-8865
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023201207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1008259Medicaid
A08631Medicare UPIN
WA1008259Medicaid