Provider Demographics
NPI:1679538847
Name:JAMES, TIMOTHY WATKINS (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WATKINS
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 YAKIMA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5303
Mailing Address - Country:US
Mailing Address - Phone:253-272-7777
Mailing Address - Fax:
Practice Address - Street 1:1802 YAKIMA AVE STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5303
Practice Address - Country:US
Practice Address - Phone:253-272-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60898176208G00000X
IL036092762208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00904921OtherMEDICARE RAILROAD (GROUP)
IL363149833OtherTAX ID
IL036092762Medicaid
CA4748OtherMEDICARE RAILROAD (GROUP)
IL1033149844OtherNPI
WA2113072Medicaid
IL206147036Medicare PIN