Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO 2753 | FL |
NPI | 1063435758 |
---|---|
Provider Name | Dr. Timothy J Whyatt |
First Address | Gainesville, FL 32605 |
Second Address | Gainesville, FL 32605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 22/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390448200 | (05) | FL |
65590 | BCBS PROVIDER # (01) | FL |
U39847 | (02) | FL |