Provider Demographics
NPI:1598887861
Name:GOODRICH, TIMOTHY W (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:509-334-5876
Mailing Address - Fax:509-332-8793
Practice Address - Street 1:825 SE BISHOP BLVD STE 601
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5512
Practice Address - Country:US
Practice Address - Phone:509-334-5876
Practice Address - Fax:509-332-8793
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0530995207Y00000X
NE774207Y00000X
AZ005600207Y00000X
GA63863207Y00000X
WAOP60500221207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOP60500221OtherWASHINGTON LICENSE
IDCS37466OtherIDAHO LICENSE-IDAHO BOARD OF PHARMACY