Provider Demographics
NPI:1760459333
Name:GAMMILL, THOMAS WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WAYNE
Last Name:GAMMILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7314 146TH ST SW
Mailing Address - Street 2:B
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98439-1229
Mailing Address - Country:US
Mailing Address - Phone:253-968-3106
Mailing Address - Fax:
Practice Address - Street 1:7314 146TH ST SW
Practice Address - Street 2:B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98439-1229
Practice Address - Country:US
Practice Address - Phone:253-968-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA20020039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant