Basic Information
| Provider Information | |||||||||
| NPI: | 1639178247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLUMLEY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | FRANKLIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1879 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985071879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605703008 | ||||||||
| FaxNumber: | 3605703006 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 ENSIGN RD NE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605703008 | ||||||||
| FaxNumber: | 3605703006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD00019291 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 113009 | 01 | WA | L&I NUMBER | OTHER | 8354607 | 05 | WA | MEDICAID |