Basic Information
| Provider Information | |||||||||
| NPI: | 1144301896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIMMS | ||||||||
| FirstName: | ESSICK | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | HS | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMDT CG-1122 US COAST GUARD | ||||||||
| Address2: | 2100 2ND ST. SW, SUITE 5314 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 205930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | COMDT CG-1122 US COAST GUARD | ||||||||
| Address2: | 2100 2ND ST. SW, SUITE 5314 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 205930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.