Timothy M Raycob, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2136 Issued in OK

Practice address

411 S Keeler, Ab-02-234C
Phillips 66 Health Services
Bartlesville, OK 74003-6670

Phone

(918) 661-6811

Fax

(918) 977-8005

NPI assigned

Jan 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1174594808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402452 W 2200 RD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740060448",
            "telephone_number": "832-477-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 S KEELER, AB-02-234C",
            "address_2": "PHILLIPS 66 HEALTH SERVICES",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740036670",
            "telephone_number": "918-661-6811",
            "fax_number": "918-977-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYCOB",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04283",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Randell, D.D.S.
• Lovetta Denise Randolph, B.S., BHRS
• Rebecca Rassel
• Chloe A Raycob
• Dori Raycob, NP-C
• Allison Grayce Redding, RDN, LD
• Gerald George Reed, D.O.
• Baylor Jayne Reese, DPT
• Jenna Lee Reese, COTA
• Jim Reeves

• Physician Assistant in Bartlesville, OK
• Providers in Bartlesville, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.