Individual
TIMOTHY B JOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1322 3RD ST SE STE 240, PUYALLUP, WA 98372-3771
(253) 848-1572
(253) 841-3719
Mailing address
10209 136TH ST E, PUYALLUP, WA 98374-3076
(253) 848-1535
(253) 848-6537
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD00015352
WA
208D00000X
General Practice Physician
Primary
MD00015352
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001502
—
WA
Enumeration date
01/15/2007
Last updated
02/16/2011
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