Healthcare Provider Details

I. General information

NPI: 1841718822
Provider Name (Legal Business Name): TYMOTHI CLAUDE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD STE 118
LITCHFIELD PARK AZ
85340-9481
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 118
LITCHFIELD PARK AZ
85340-9481
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-2600
  • Fax: 623-547-1899
Mailing address:
  • Phone: 623-547-2600
  • Fax: 623-547-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6915
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: