Provider Demographics
NPI:1073204681
Name:TIMOTHY R RASMUSSON MD, PC
Entity Type:Organization
Organization Name:TIMOTHY R RASMUSSON MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RASMUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-204-9729
Mailing Address - Street 1:2914 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1332
Mailing Address - Country:US
Mailing Address - Phone:716-204-9729
Mailing Address - Fax:716-204-9406
Practice Address - Street 1:2914 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1332
Practice Address - Country:US
Practice Address - Phone:716-204-9729
Practice Address - Fax:716-204-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty