Healthcare Provider Details

I. General information

NPI: 1639224074
Provider Name (Legal Business Name): TIMOTHY D LOCKNANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE SUITE H-210
KIRKLAND WA
98034-3027
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-4000
  • Fax: 425-821-3550
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD00036179
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: