Healthcare Provider Details

I. General information

NPI: 1396066601
Provider Name (Legal Business Name): TIMOTHY DEVON REPLOGLE II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7964 SUMMERLIN LAKES DR
FORT MYERS FL
33907-1816
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501
HUNT VALLEY MD
21031-7531
US

V. Phone/Fax

Practice location:
  • Phone: 239-333-1177
  • Fax: 239-333-1169
Mailing address:
  • Phone: 703-914-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME122640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: