Provider Demographics
NPI:1336333830
Name:CONNALL, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:CONNALL
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 1:19801 SW 72ND AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8351
Mailing Address - Country:US
Mailing Address - Phone:503-783-0544
Mailing Address - Fax:
Practice Address - Street 1:19801 SW 72ND AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8351
Practice Address - Country:US
Practice Address - Phone:503-783-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR240982086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery