Healthcare Provider Details

I. General information

NPI: 1730385410
Provider Name (Legal Business Name): TIMOTHY JOHN FLOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N 18TH AVE SUITE 550
PHOENIX AZ
85007-3232
US

IV. Provider business mailing address

150 N 18TH AVE SUITE 550
PHOENIX AZ
85007-3232
US

V. Phone/Fax

Practice location:
  • Phone: 602-542-7331
  • Fax:
Mailing address:
  • Phone: 602-542-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number11373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: