Provider Demographics
NPI:1710969357
Name:ANDERSON, TIMOTHY SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:ANDERSON
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:18208 66TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-485-6561
Practice Address - Fax:425-488-4939
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8150070Medicaid
WAAN6337OtherBLUE SHIELD
WA104369OtherLABOR & INDUSTRIES
WA080076923OtherMEDICARE RAILROAD
WAD33715Medicare UPIN
WA8150070Medicaid
WAG8897715Medicare PIN