Provider Demographics
NPI:1508936212
Name:DIBBLE, TIMOTHY DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:DIBBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T
Other - Middle Name:DANIEL
Other - Last Name:DIBBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-0808
Mailing Address - Country:US
Mailing Address - Phone:509-363-3100
Mailing Address - Fax:509-363-0300
Practice Address - Street 1:1123 N EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1138
Practice Address - Country:US
Practice Address - Phone:509-363-3100
Practice Address - Fax:509-363-0300
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7950208VP0014X, 207LP2900X
WAMD00042632208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ9109OtherRAILROAD MEDICARE
WA157490OtherLABOR & INDUSTRIES
ID805808900Medicaid
WA1115443Medicaid
WA125300300OtherUS DEPT OF LABOR-OWCP
G08715Medicare UPIN
WACJ9109OtherRAILROAD MEDICARE
WA050086686Medicare ID - Type UnspecifiedPALMETTO RAILROAD MEDICRE