Healthcare Provider Details

I. General information

NPI: 1750511333
Provider Name (Legal Business Name): TIMOTHY SCOTT SAXON DME SUPPLIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIMOTHY SCOTT SAXON DME SUPPLIER

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13221 GOLF RIDGE PL
HUDSON FL
34669-2461
US

IV. Provider business mailing address

13221 GOLF RIDGE PL
HUDSON FL
34669
US

V. Phone/Fax

Practice location:
  • Phone: 727-207-0093
  • Fax:
Mailing address:
  • Phone: 727-207-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number255-431-006
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number255431006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: