Healthcare Provider Details

I. General information

NPI: 1033344791
Provider Name (Legal Business Name): CARRI JO TIMMER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRI JO JOHNSON D.O.

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 PACIFIC AVENUE PARKLAND CLINIC
TACOMA WA
98444
US

IV. Provider business mailing address

1019 PACIFIC AVE STE 300 ATTN: CREDENTIALING
TACOMA WA
98402-4488
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-2020
  • Fax: 253-536-5327
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60221510
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: