Individual
TIMOTHY JOHN COGLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
4245 ROOSEVELT WAY NE, SEATTLE, WA 98105-6008
(206) 543-6420
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10000065
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8595704
—
WA
Enumeration date
07/03/2006
Last updated
03/24/2009
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