Healthcare Provider Details

I. General information

NPI: 1710969357
Provider Name (Legal Business Name): TIMOTHY SCOTT ANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18208 66TH AVE NE SUITE 200
KENMORE WA
98028-7949
US

IV. Provider business mailing address

PO BOX 34036
SEATTLE WA
98124-1036
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-6561
  • Fax: 425-488-4939
Mailing address:
  • Phone: 425-899-3292
  • Fax: 425-899-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00000868
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: