Provider Demographics
NPI:1750471496
Name:FORSLUND, TIMOTHY MJ (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MJ
Last Name:FORSLUND
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 1:1932 1ST AVE
Mailing Address - Street 2:STE 604
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1040
Mailing Address - Country:US
Mailing Address - Phone:206-443-9379
Mailing Address - Fax:888-981-4965
Practice Address - Street 1:1932 1ST AVE
Practice Address - Street 2:STE 604
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1040
Practice Address - Country:US
Practice Address - Phone:206-443-9379
Practice Address - Fax:206-632-2437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000338522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8154155Medicaid
WA8154155Medicaid
WAGAB09774Medicare PIN