Provider Demographics
NPI:1275539660
Name:HALL, TIMOTHY R (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7554 15TH AVE NW
Mailing Address - Street 2:BALLARD PEDIATRIC CLINIC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:206-783-9300
Mailing Address - Fax:206-588-0531
Practice Address - Street 1:7554 15TH AVE NW
Practice Address - Street 2:BALLARD PEDIATRIC CLINIC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-783-9300
Practice Address - Fax:206-588-0531
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100885208000000X
WAMD60217406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891297TMedicaid
NC891297TMedicaid