MEDICARE: DR. TIMOTHY RUPERT DOOLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G69284	CA

General Provider Information

NPI Number	:	1366557258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY RUPERT DOOLEY MD

Provider Business Mailing Address
First Line	:	3446 PARK BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5209
Country	:	US
Telephone Number	:	619-297-8641
Fax Number	:	619-272-9474

Provider Business Practice Location Address
First Line	:	2525 CAMINO DEL RIO S STE 130
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3718
Country	:	US
Telephone Number	:	619-297-8641
Fax Number	:	619-272-9474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2022

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