Provider Demographics
NPI:1144391350
Name:NOREUIL, TIMOTHY O (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:O
Last Name:NOREUIL
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 1:3868 SE DEER CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8497
Mailing Address - Country:US
Mailing Address - Phone:503-413-7711
Mailing Address - Fax:
Practice Address - Street 1:3868 SE DEER CREEK WAY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8497
Practice Address - Country:US
Practice Address - Phone:503-413-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090830207L00000X
ORMD17778207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090830001Medicaid
OR500609152Medicaid
WA8549487Medicaid
ORR147887Medicare PIN
WA8549487Medicaid