Provider Demographics
NPI:1245235456
Name:TOMPSON, RICHARD GRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GRAY
Last Name:TOMPSON
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 1:1410 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4754
Mailing Address - Country:US
Mailing Address - Phone:417-256-2225
Mailing Address - Fax:417-256-2373
Practice Address - Street 1:1410 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4754
Practice Address - Country:US
Practice Address - Phone:417-256-2225
Practice Address - Fax:417-256-2373
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 102941207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208595314Medicaid
MO208595314Medicaid
MO952664510Medicare PIN
MO000014510Medicare PIN
MOG26803Medicare UPIN
MO952664511Medicare PIN