Individual
TRACY TIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
505 NE 87TH AVE, SUITE 301, VANCOUVER, WA 98664-1989
(360) 514-1854
(360) 514-6063
Mailing address
1115 SE 164TH AVE, DEPT 358, VANCOUVER, WA 98683-9324
(360) 729-1253
(360) 575-3678
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101240754
VA
2086S0102X
Surgical Critical Care Physician
D71167
MD
2086S0127X
Trauma Surgery Physician
D71167
MD
2086S0127X
Trauma Surgery Physician
Primary
MD60449813
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131
BLUE CROSS
MD
05
—
323207700
—
MD
Enumeration date
05/23/2007
Last updated
05/02/2014
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