Provider Demographics
NPI:1710094131
Name:BREI, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:BREI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:OC.9.840
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-3664
Mailing Address - Fax:206-987-3824
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:OC.9.840
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-3664
Practice Address - Fax:206-987-3824
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN010377802080P0006X
WA603623082080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100130650Medicaid
MI1710094131Medicaid
350593390-042OtherTRICARE-DEAC-350593390
KY64882285Medicaid
IN145590X5Medicare PIN
350593390-042OtherTRICARE-DEAC-350593390