Provider Demographics
NPI:1992497903
Name:ROUSSEAU, TIMOTHY ARTHUR (PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ARTHUR
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4472 BATTLEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4480
Mailing Address - Country:US
Mailing Address - Phone:770-375-0998
Mailing Address - Fax:
Practice Address - Street 1:9521 SAN MATEO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2237
Practice Address - Country:US
Practice Address - Phone:505-923-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant