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General NPI Number Information
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NPI Number | 1124149315
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Entity Type | Individual
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Provider Name | TIMOTHY P LIDDY HAD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 42382 BOB HOPE DRIVE
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270
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Country | US
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Telephone | 760-341-9619
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Fax | 314-839-5215
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Provider Business Mailing Address
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Address Line | 8800 SE SUNNYSIDE RD. STE. 300-N
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City | CLACKAMAS
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State | OR
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Zip | 97015-5738
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Country | US
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Telephone | 503-659-5115
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Fax | 816-792-9819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2005030823
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 7721
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License Number State | CA
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