Individual
TIMOTHY MICHAEL COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 E WILLIAMS AVE, FALLON, NV 89406-3052
(775) 867-7740
(775) 423-4219
Mailing address
801 E WILLIAMS AVE STE 2210, FALLON, NV 89406-3052
(775) 867-7740
(775) 423-4219
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6380851-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB3302
MEDICARE RR GROUP
UT
01
—
P00379498
MEDICARE RR
UT
Enumeration date
01/22/2007
Last updated
10/05/2020
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