Provider Demographics
NPI:1760996037
Name:TIMPE, DOUGLAS LYLE
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LYLE
Last Name:TIMPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 VALLEY MALL PKWY # 346
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4831
Mailing Address - Country:US
Mailing Address - Phone:425-891-2069
Mailing Address - Fax:
Practice Address - Street 1:1028 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1532
Practice Address - Country:US
Practice Address - Phone:512-763-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC60348165246RP1900X
WAES60075668146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy