Provider Demographics
NPI:1750349486
Name:TOMBERLIN, MARCUS GUY (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:GUY
Last Name:TOMBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-788-8150
Mailing Address - Fax:360-733-0119
Practice Address - Street 1:1115 SE 164TH AVE
Practice Address - Street 2:DEPT 358
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9324
Practice Address - Country:US
Practice Address - Phone:360-788-8150
Practice Address - Fax:360-733-0119
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044613207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG22538Medicare UPIN
WA8853043Medicare ID - Type Unspecified