Provider Demographics
NPI:1134292972
Name:TOBIN, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
Last Name:TOBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000239672085R0204X
WAMD000463042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA40713OtherLABOR AND INDUSTRIES/WC TRA
WA0249555OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA8125346Medicaid
WA8946139OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA8951858OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WATO7580OtherREGENCE BLUE SHIELD TRA
WA0260103OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA7252TOOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WAAB36529OtherMEDICARE PIN TRA KING COUNTY
WAG8881791OtherPTAN-MIO1
WA30022483OtherRR MEDICARE TRA
WA8945850OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA8125346Medicaid
WA30022483OtherRR MEDICARE TRA
WAGAB36529Medicare PIN