Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 10201 | MT |
NPI | 1194774877 |
---|---|
Provider Name | Dr. Timothy Albert Dumontier |
First Address | Olympia, WA 98507-0368 |
Second Address | Olympia, WA 98502-8654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194774877 | (05) | MT |
1194774877 | BCBS (01) | MT |