Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 1229 | NE |
N | 208000000X | Pediatrician | OP60632905 | WA |
N | 2080P0203X | Pediatric Critical Care Doctor | 1229 | NE |
Y | 2080P0203X | Pediatric Critical Care Doctor | OP60632905 | WA |
NPI | 1174966477 |
---|---|
Provider Name | Matthew Timlin |
First Address | Tacoma, WA 98431-1100 |
Second Address | Tacoma, WA 98431-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60632905 | (05) | WA |