Provider Demographics
NPI:1861400970
Name:MONK, THOMAS RALPH (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RALPH
Last Name:MONK
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 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:945 HILDEBRAND LN NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2877
Practice Address - Country:US
Practice Address - Phone:206-991-2121
Practice Address - Fax:206-991-2151
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8385437Medicaid
3643756OtherCIGNA
9454MOOtherREGENCE
WA224869OtherLABOR & INDUSTRIES
4203823OtherAETNA
WA224869OtherLABOR & INDUSTRIES
4203823OtherAETNA
A07032Medicare UPIN
G8879514Medicare PIN
3643756OtherCIGNA
G8893790Medicare PIN