Provider Demographics
NPI:1356329817
Name:GACIOCH, TIMOTHY PAUL (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:GACIOCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4147
Mailing Address - Country:US
Mailing Address - Phone:406-750-3519
Mailing Address - Fax:
Practice Address - Street 1:4300 PERIMETER RD
Practice Address - Street 2:(341ST MED GROUP) BLDG 2040, ROOM S156
Practice Address - City:MALMSTROM AFB
Practice Address - State:MT
Practice Address - Zip Code:59402-0001
Practice Address - Country:US
Practice Address - Phone:406-731-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical