1164656948 NPI number — TIMOTHY R. DRIVER, MD P.C.

Table of content: (NPI 1164656948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164656948 NPI number — TIMOTHY R. DRIVER, MD P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY R. DRIVER, MD P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1164656948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 DOCTORS PARK DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-8198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-772-6600
Provider Business Mailing Address Fax Number:
541-779-1266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 DOCTORS PARK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-8198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-772-6600
Provider Business Practice Location Address Fax Number:
541-779-1266
Provider Enumeration Date:
05/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DRIVER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-772-6600

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  MD10723 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 262725 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001930003 . This is a "BCBS PIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com