Provider Demographics
NPI:1669531570
Name:BELCHER, TIMOTHY A (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:BELCHER
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 1:5126 CR 3400
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KS
Mailing Address - Zip Code:67357
Mailing Address - Country:US
Mailing Address - Phone:620-485-3255
Mailing Address - Fax:
Practice Address - Street 1:1400 W 4TH STREET
Practice Address - Street 2:COFFEYVILLE REGIONAL MEDICAL CENTER ER DEPARTMENT
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337
Practice Address - Country:US
Practice Address - Phone:620-252-1649
Practice Address - Fax:620-252-1699
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19449Medicare UPIN
KS058826Medicare ID - Type Unspecified