Provider Demographics
NPI:1184650046
Name:RASOR, TIMOTHY B (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:RASOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N1750 LILY OF THE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-9044
Mailing Address - Country:US
Mailing Address - Phone:920-757-5170
Mailing Address - Fax:920-757-6589
Practice Address - Street 1:N1750 LILY OF THE VALLEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-9044
Practice Address - Country:US
Practice Address - Phone:920-757-5170
Practice Address - Fax:920-757-6589
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27767-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30791200Medicaid
WIE48785Medicare UPIN