Individual provider · Type 1 NPI

Timothy Black, PA

Surgical Physician Assistant · Vancouver, WA

NPI number 1730167271 Active

Practice location

200 NE Mother Joseph Pl, Suite 110
Vancouver, WA 98664

Fax (360) 449-1146

Mailing address

200 NE Mother Joseph Pl Ste 210
Vancouver, WA 98664-3295

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XPA60650228 (WA)
Surgical Physician Assistant Primary 363AS0400XNone listed

Surgical Physician Assistant: Definition to come...

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About NPI 1730167271

Timothy Black, PA's National Provider Identifier is 1730167271, issued on Jan 5, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Vancouver, WA. The record was last updated on Aug 7, 2018.