Healthcare Provider Details

I. General information

NPI: 1992723647
Provider Name (Legal Business Name): TIMOTHY MARTIN SYPEREK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8262 POINT MEADOWS DR STE 202
JACKSONVILLE FL
32256-4700
US

IV. Provider business mailing address

705 WELLS RD STE 300
ORANGE PARK FL
32073-2982
US

V. Phone/Fax

Practice location:
  • Phone: 904-265-0470
  • Fax: 904-223-3949
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-282-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3414
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: