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General NPI Number Information
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NPI Number | 1457677627
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Entity Type | Individual
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Provider Name | TIMOTHY MITCHELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 2525 NE 139TH ST STE 270
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City | VANCOUVER
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State | WA
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Zip | 98686-2719
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Country | US
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Telephone | 360-882-2778
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Fax | 360-604-1672
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Provider Business Mailing Address
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Address Line | 700 NE 87TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98664-4896
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Country | US
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Telephone | 360-882-2778
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Fax |
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | MD182505
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | MD60462303
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License Number State | WA
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