Healthcare Provider Details

I. General information

NPI: 1831174390
Provider Name (Legal Business Name): TIMOTHY R TOMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HAND AVE
BAY MINETTE AL
36507-4110
US

IV. Provider business mailing address

PO BOX 10583
BIRMINGHAM AL
35202-0583
US

V. Phone/Fax

Practice location:
  • Phone: 251-937-5521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02283
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.339
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO.339
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: