Basic Information
| Provider Information | |||||||||
| NPI: | 1770018087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORROCKS | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 CALIFORNIA AVE APT A | ||||||||
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| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631042234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357644261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 527 2ND ST | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986748486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602258911 | ||||||||
| FaxNumber: | 3602258527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | MD61061975 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.