Healthcare Provider Details

I. General information

NPI: 1487621942
Provider Name (Legal Business Name): TIM ANDREW COFFEY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL DEPARTMENT USS ABRAHAM LINCOLN FPO-AP
EVERETT WA
96612-2872
US

IV. Provider business mailing address

13017 42ND AVE SE
EVERETT WA
98208
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-5123
  • Fax: 425-304-5166
Mailing address:
  • Phone: 425-337-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: