Provider Demographics
NPI:1194429431
Name:TEUSINK, TIMOTHY RAY
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:TEUSINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 SUMMITVIEW AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3005
Mailing Address - Country:US
Mailing Address - Phone:509-208-4912
Mailing Address - Fax:
Practice Address - Street 1:1300 N 1ST ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1702
Practice Address - Country:US
Practice Address - Phone:509-853-4327
Practice Address - Fax:509-853-1007
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine