Provider Demographics
NPI:1548586050
Name:TOMPKINS, KENNETH DEAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DEAN
Last Name:TOMPKINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17780 E PURDUE PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3333
Mailing Address - Country:US
Mailing Address - Phone:573-823-6004
Mailing Address - Fax:303-773-3101
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2709
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-773-3101
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO52571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53237579Medicaid
CO298880YLMEMedicare PIN
CO53237579Medicaid