Provider Demographics
NPI:1487621942
Name:COFFEY, TIM ANDREW (IDC)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:ANDREW
Last Name:COFFEY
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 1:13017 42ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-337-3843
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL DEPARTMENT USS ABRAHAM LINCOLN
Practice Address - Street 2:FPO-AP
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:96612-2872
Practice Address - Country:US
Practice Address - Phone:425-304-5123
Practice Address - Fax:425-304-5166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman