Healthcare Provider Details

I. General information

NPI: 1932257094
Provider Name (Legal Business Name): TIMOTHY RENFREW OELTMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARINE AIRCRAFT GROUP 39 MEDICAL
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

MAG-39 MEDICAL
CAMP PENDLETON CA
92055-0000
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-2969
  • Fax:
Mailing address:
  • Phone: 760-725-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number27119
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: