MEDICARE: DR. TIMOTHY PATRICK CONNALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	24098	OR

General Provider Information

NPI Number	:	1336333830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY PATRICK CONNALL M.D.

Provider Business Mailing Address
First Line	:	19801 SW 72ND AVE
Second Line	:	SUITE 160
City	:	TUALATIN
State	:	OR
Zip	:	97062-8351
Country	:	US
Telephone Number	:	503-783-0544
Fax Number	:

Provider Business Practice Location Address
First Line	:	19801 SW 72ND AVE
Second Line	:	SUITE 160
City	:	TUALATIN
State	:	OR
Zip	:	97062-8351
Country	:	US
Telephone Number	:	503-783-0544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	06/16/2016

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