Provider Demographics
NPI:1598496812
Name:BOORADY, TIMOTHY W (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:BOORADY
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 1:101 BODIN CIRCLE
Mailing Address - Street 2:BUILDING 777 60TH MEDICAL GROUP
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1801
Mailing Address - Country:US
Mailing Address - Phone:716-200-6513
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR BLDG 777
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program