Healthcare Provider Details

I. General information

NPI: 1013275486
Provider Name (Legal Business Name): TIMOTHY TODD FLEENOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

619 19TH ST S
BIRMINGHAM AL
35249-1900
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-5004
  • Fax:
Mailing address:
  • Phone: 205-934-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.34510
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.34510
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: