Individual
TIMOTHY M BAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 296-7724
(541) 296-7605
Mailing address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 296-7724
(541) 296-7605
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA195591
PA-C MEDICAL LICENSE
OR
Enumeration date
08/21/2019
Last updated
08/28/2024
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