Provider Demographics
NPI:1780614560
Name:MCGARITY, TIMOTHY DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DOUGLAS
Last Name:MCGARITY
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 1:1410 FORUM KATY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6325
Mailing Address - Country:US
Mailing Address - Phone:573-441-7070
Mailing Address - Fax:573-441-2288
Practice Address - Street 1:1410 FORUM KATY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6325
Practice Address - Country:US
Practice Address - Phone:573-441-7070
Practice Address - Fax:573-441-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006011484207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201329604Medicaid
MO751788OtherHEALTHLINK
MO209074OtherBLUE CHOICE
MO957215236Medicare PIN
MO957211910Medicare PIN
MO209074OtherBLUE CHOICE
MOP00430572Medicare PIN
MOP00327009Medicare PIN