Provider Demographics
NPI:1477382596
Name:COWART, TIMOTHY BROOKS (IDC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:BROOKS
Last Name:COWART
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 EAGER RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-9536
Mailing Address - Country:US
Mailing Address - Phone:206-819-1813
Mailing Address - Fax:
Practice Address - Street 1:2886 EAGER RD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-9536
Practice Address - Country:US
Practice Address - Phone:206-819-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman