Individual
TIMOTHY D OLTHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
810 WHIPPLE ST, PRESCOTT, AZ 86301-1606
(928) 771-7577
(928) 458-2080
Mailing address
10835 N 25TH AVE, STE 240, PHOENIX, AZ 85029-3458
(219) 464-4891
(219) 464-1873
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
006190
AZ
2085R0202X
Diagnostic Radiology Physician
02002900
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200521590
—
IN
01
—
P00324999
RR MEDICARE
IN
Enumeration date
11/07/2005
Last updated
07/21/2022
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