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General NPI Number Information
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NPI Number | 1588733604
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Entity Type | Individual
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Provider Name | TIMOTHY MARK KOBERNIK D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CTR 9040 REID ST. ATTN MCHJ-QCR
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City | TACOMA
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State | WA
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Zip | 98431-1100
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Country | US
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Telephone | 253-968-6033
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Fax | 253-968-2826
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Provider Business Mailing Address
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Address Line | MADIGAN ARMY MEDICAL CTR 9040 REID ST. ATTN MCHJ-QCR
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City | TACOMA
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State | WA
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Zip | 98431-1100
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Country | US
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Telephone | 253-968-6033
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Fax | 253-968-2826
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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 | OP00002182
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License Number State | WA
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