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NPI Code Detail

MEDICARE: TIMOTHY S GORMLEY MD

MEDICARE: TIMOTHY S GORMLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD035310DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043200686
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY S GORMLEY MD
Provider Business Mailing Address
First Line : MSC 1023
Second Line : P.O. BOX 2300
City : SPOKANE
State : WA
Zip : 99210
Country : US
Telephone Number : 509-946-4611
Fax Number : 509-943-9272
Provider Business Practice Location Address
First Line : 888 SWIFT BLVD
Second Line :
City : RICHLAND
State : WA
Zip : 99352-3514
Country : US
Telephone Number : 509-946-4611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 12/06/2007

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Directions to “ TIMOTHY S GORMLEY MD” Practice Location

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