Healthcare Provider Details

I. General information

NPI: 1164466058
Provider Name (Legal Business Name): TIMOTHY S BALTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 MEDICAL CENTER PKWY
SELMA AL
36701-6780
US

IV. Provider business mailing address

1017 MEDICAL CENTER PKWY
SELMA AL
36701-6780
US

V. Phone/Fax

Practice location:
  • Phone: 334-875-2100
  • Fax: 334-418-6540
Mailing address:
  • Phone: 334-875-2100
  • Fax: 334-418-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00011490
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: