Provider Demographics
NPI:1639178247
Name:PLUMLEY, THOMAS FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRANKLIN
Last Name:PLUMLEY
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 1879
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-1879
Mailing Address - Country:US
Mailing Address - Phone:360-570-3008
Mailing Address - Fax:360-570-3006
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-570-3008
Practice Address - Fax:360-570-3006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000192912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA113009OtherL&I NUMBER
WA8354607Medicaid
WA8354607Medicaid