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Individual

MR. TIMOTHY BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
200 NE MOTHER JOSEPH PL, SUITE 110, VANCOUVER, WA 98664
(360) 254-6161
(360) 449-1146
Mailing address
200 NE MOTHER JOSEPH PL STE 210, VANCOUVER, WA 98664-3295
(360) 254-6161
(360) 449-1146

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60650228
WA
363AS0400X
Surgical Physician Assistant
Primary
WA

Other

Enumeration date
01/05/2006
Last updated
08/07/2018
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