MEDICARE: TIMOTHY W GOLDING ACUPUNCTURE PHYSICIA

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	171100000X	Acupuncturist	AP1708	FL
2	171100000X	Acupuncturist	001832-1	NY

General Provider Information

NPI Number	:	1477769511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY W GOLDING ACUPUNCTURE PHYSICIA

Provider Business Mailing Address
First Line	:	961 LISKEARD AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-5733
Country	:	US
Telephone Number	:	386-801-6970
Fax Number	:	386-775-6915

Provider Business Practice Location Address
First Line	:	961 LISKEARD AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-5733
Country	:	US
Telephone Number	:	386-801-6970
Fax Number	:	386-775-6915

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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