Provider Demographics
NPI:1023088374
Name:MASSEY, TIMOTHY HAYES (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HAYES
Last Name:MASSEY
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 1:11821 NE 128TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7210
Mailing Address - Country:US
Mailing Address - Phone:425-823-8282
Mailing Address - Fax:425-823-6696
Practice Address - Street 1:11821 NE 128TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:425-823-8282
Practice Address - Fax:425-823-6696
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030689207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA48820OtherDEPT. OF LABOR & INDUSTRI
WA8154072/7040033Medicaid
WAMA6448OtherREGENCE BLUE SHIELD NUMBE
WA8154072/7040033Medicaid