Provider Demographics
NPI:1417558263
Name:MCCABE, TIMOTHY MATTHEW NEIL (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MATTHEW NEIL
Last Name:MCCABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:607 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1345
Mailing Address - Country:US
Mailing Address - Phone:208-983-1700
Mailing Address - Fax:208-983-4665
Practice Address - Street 1:1150 ALTURAS DR STE 101
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3263
Practice Address - Country:US
Practice Address - Phone:208-310-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-15471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine