Healthcare Provider Details

I. General information

NPI: 1720553704
Provider Name (Legal Business Name): TIM HAGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 CALIFORNIA AVE SW
SEATTLE WA
98116-4110
US

IV. Provider business mailing address

4519 CALIFORNIA AVE SW
SEATTLE WA
98116-4110
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-3711
  • Fax:
Mailing address:
  • Phone: 206-938-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: