Provider Demographics
NPI:1225058308
Name:SONCASIE, TIMOTHY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:SONCASIE
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 1:900 W NIFONG BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4469
Mailing Address - Country:US
Mailing Address - Phone:573-499-9009
Mailing Address - Fax:573-499-4400
Practice Address - Street 1:900 W NIFONG BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-499-9009
Practice Address - Fax:573-499-4400
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111504207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208504514Medicaid
MOP00349316OtherRR MEDICARE
MO959054992Medicare PIN
MO208504514Medicaid