Randall, Timothy A

Randall, Timothy A is an individual health care provider with primary practice located at 1718 E Kessler Blvd , Longview WA 98632-1842. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Randall, Timothy A can be contacted via phone (360) 747-5800.

Contact Information

Primary practice address
1718 E Kessler Blvd Longview WA 98632-1842
Phone: (360) 747-5800
Fax: (360) 575-3846
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00030595 Washington

Profile Details

NPI number 1245237262
LBN Legal business name Randall, Timothy A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2005
Last updated Jul 30th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245237262 NPPES
Washington Other 81334 LABOR & IND
Washington Other 080099846 LABOR & IND
Washington MEDICAID 057278 LABOR & IND
Washington MEDICAID 8148116 LABOR & IND
Washington Other 8933772 LABOR & IND

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