Provider Demographics
NPI:1407924541
Name:SAPP, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:SAPP
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 1:6015 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1213
Mailing Address - Country:US
Mailing Address - Phone:623-344-4400
Mailing Address - Fax:623-344-4450
Practice Address - Street 1:6015 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1213
Practice Address - Country:US
Practice Address - Phone:623-344-4400
Practice Address - Fax:623-344-4450
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ307802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ817596Medicaid
AZZ124570Medicare PIN
AZ817596Medicaid
AZF94274Medicare UPIN