Individual
MR. TIMOTHY SCOTT CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PA00732
OR
363AS0400X
Surgical Physician Assistant
Primary
PA00732
OR
Other
Enumeration date
10/22/2007
Last updated
08/20/2015
Update your record
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