Provider Demographics
NPI:1265503742
Name:ATKINSON, TIMOTHY W (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY RD # 7440
Mailing Address - Street 2:COMMANDER, USA-MEDDAC-AK ATTN MCUC-MMD-QM(CREDENTIALS)
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5001
Mailing Address - Country:US
Mailing Address - Phone:907-353-5418
Mailing Address - Fax:907-353-4847
Practice Address - Street 1:1060 GAFFNEY RD # 7440
Practice Address - Street 2:COMMANDER, USA-MEDDAC-AK ATTN MCUC-MMD-QM(CREDENTIALS)
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5001
Practice Address - Country:US
Practice Address - Phone:907-353-5418
Practice Address - Fax:907-353-4847
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK260363AM0700X
WAPA 1004563363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care