Provider Demographics
NPI:1962606400
Name:HYATT, TIMOTHY P (ND)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:HYATT
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MERIDIAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2752
Mailing Address - Country:US
Mailing Address - Phone:503-476-3182
Mailing Address - Fax:
Practice Address - Street 1:201 N MERIDIAN ST STE B
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2752
Practice Address - Country:US
Practice Address - Phone:503-476-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1539175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath