Individual
TIMOTHY O MCBRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 E MAIN ST, JOHNSON CITY, TN 37601-4877
(423) 929-2584
(423) 722-2060
Mailing address
401 E MAIN ST, JOHNSON CITY, TN 37601-4877
(423) 929-2584
(423) 722-2060
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101229648
VA
207R00000X
Internal Medicine Physician
43798
TN
208000000X
Pediatrics Physician
0101229648
VA
208000000X
Pediatrics Physician
43798
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010142865
—
VA
01
—
43793
LICENSE
TN
Enumeration date
07/07/2006
Last updated
11/04/2013
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