MEDICARE: TIMOTHY BRYAN PEKARI DSC-PA

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
1	363AS0400X	Surgical Physician Assistant	PA0005635	CO
2	363A00000X	Physician Assistant	1098276	NC
3	363AS0400X	Surgical Physician Assistant	PA61663743	WA
4	363A00000X	Physician Assistant	PA10199	TX

General Provider Information

NPI Number	:	1720361405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY BRYAN PEKARI DSC-PA

Provider Business Mailing Address
First Line	:	16315 N WOODCREST CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-7550
Country	:	US
Telephone Number	:	719-526-7440
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 E CENTRAL AVE STE 140
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-6289
Country	:	US
Telephone Number	:	509-465-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	03/03/2026

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