Provider Demographics
NPI:1538147491
Name:MCCANN, TIMOTHY J (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63188-0551
Mailing Address - Country:US
Mailing Address - Phone:314-898-1700
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:1717 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-3454
Practice Address - Country:US
Practice Address - Phone:314-898-1700
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7555001OtherAETNA
110232845OtherRR MEDICARE
210829OtherHEALTHLINK
431890869OtherGREAT WEST
0450305OtherUHC
1160032OtherCARE PARTNERS
A11697OtherMERCY
112907OtherBCBS MO
2632OtherGHP ALL
0035221OtherCARPENTERS SUPPLEMENT
MO104220083OtherMEDICARE ID-TYPE
2632OtherHEALTHCARE USA
431890869OtherHEALTH NET FEDERAL
MOMA1730004Medicare PIN
0035221OtherCARPENTERS SUPPLEMENT