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General NPI Number Information
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NPI Number | 1568574549
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Entity Type | Individual
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Provider Name | TIMOTHY VAN ERT M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 115 NE MAY LN
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City | MCMINNVILLE
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State | OR
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Zip | 97128-9272
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Country | US
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Telephone | 503-472-1338
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Fax | 503-434-8597
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Provider Business Mailing Address
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Address Line | 7201 N INTERSTATE AVE
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City | PORTLAND
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State | OR
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Zip | 97217-5523
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Country | US
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Telephone | 503-813-2000
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Fax | 855-524-5255
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16355 MD
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00031237
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License Number State | WA
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