Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 2011017333 | MO |
Y | 207YS0123X | Facial Plastic Surgeon | OS 13941 | FL |
NPI | 1720376247 |
---|---|
Provider Name | Dr. Timothy Seth Tudor |
First Address | Sebastian, FL 32958-3772 |
Second Address | Sebastian, FL 32958-3772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 27/07/2016 |