Individual
TIM NG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
747 BROADWAY, SEATTLE, WA 98122-4307
(206) 386-6000
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OP60920717
WA
208M00000X
Hospitalist Physician
Primary
OP60920717
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154718377
—
WA
Enumeration date
04/26/2015
Last updated
10/02/2023
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