Provider Demographics
NPI:1306827795
Name:MCCORD, TIMOTHY I (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:I
Last Name:MCCORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4281
Mailing Address - Country:US
Mailing Address - Phone:425-259-3757
Mailing Address - Fax:425-259-6565
Practice Address - Street 1:3401 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4281
Practice Address - Country:US
Practice Address - Phone:425-259-3757
Practice Address - Fax:425-259-6565
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000371213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1014315Medicaid
WAG001200885Medicare ID - Type Unspecified
WA1014315Medicaid
WA0204100001Medicare NSC