MEDICARE: TIMOTHY RAY DEER 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	0101053793	VA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	17647	WV
3	208VP0014X	Interventional Pain Medicine Physician	0101053793	VA
4	208VP0014X	Interventional Pain Medicine Physician	17647	WV

General Provider Information

NPI Number	:	1861424210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RAY DEER MD

Provider Business Mailing Address
First Line	:	400 COURT ST STE 100
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1652
Country	:	US
Telephone Number	:	304-347-6120
Fax Number	:	304-347-6126

Provider Business Practice Location Address
First Line	:	400 COURT ST STE 100
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1652
Country	:	US
Telephone Number	:	304-347-6120
Fax Number	:	304-347-6126

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/22/2025

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