1215946355 NPI number — TIMOTHY F DOWLING DO

Table of content: TIMOTHY F DOWLING DO (NPI 1215946355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215946355 NPI number — TIMOTHY F DOWLING DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWLING
Provider First Name:
TIMOTHY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215946355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 CLUB DR STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94592-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1222 PINE ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT HELENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94574-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-963-0931
Provider Business Practice Location Address Fax Number:
707-254-1779
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C20004476 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 18094 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000745903 . This is a "DELAWARE PHYSICIANS CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510064326 . This is a "AETNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000745903 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6124015 . This is a "BCBS OF DE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0880974000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 863637 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27825 . This is a "CAVENTRY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com