Provider Demographics
NPI:1619960168
Name:TOMPKINS, JON STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:STEPHEN
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2371
Mailing Address - Country:US
Mailing Address - Phone:903-577-7003
Mailing Address - Fax:903-577-3933
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2371
Practice Address - Country:US
Practice Address - Phone:903-577-7003
Practice Address - Fax:903-577-3933
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-4869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67738Medicare UPIN
TX00N755Medicare ID - Type Unspecified