Basic Information
Provider Information
NPI: 1003012592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCORD
FirstName: TIMOTHY
MiddleName: JASON
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3801 BLUE PKWY
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641302807
CountryCode: US
TelephoneNumber: 8169223166
FaxNumber:  
Practice Location
Address1: 3801 BLUE PKWY
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641302807
CountryCode: US
TelephoneNumber: 8169223166
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2007
LastUpdateDate: 07/26/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0804X2012025297MOY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry

No ID Information.


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