Provider Demographics
NPI:1033344791
Name:TIMMER, CARRI JO (DO)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:JO
Last Name:TIMMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARRI
Other - Middle Name:JO
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1019 PACIFIC AVE STE 300
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4488
Mailing Address - Country:US
Mailing Address - Phone:253-722-1540
Mailing Address - Fax:253-597-4556
Practice Address - Street 1:11225 PACIFIC AVENUE
Practice Address - Street 2:PARKLAND CLINIC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-536-2020
Practice Address - Fax:253-536-5327
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60221510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine