Provider Demographics
NPI:1053327064
Name:ISAACS, TIMOTHY FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FREDERICK
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CAMPUS DRIVE
Mailing Address - Street 2:#301
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-992-2223
Mailing Address - Fax:415-861-8073
Practice Address - Street 1:901 CAMPUS DRIVE
Practice Address - Street 2:#301
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-992-2223
Practice Address - Fax:415-861-8073
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG191952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8402917Medicaid
CA8402917Medicaid
00G191950Medicare ID - Type Unspecified