Healthcare Provider Details

I. General information

NPI: 1316063357
Provider Name (Legal Business Name): TIMOTHY M ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N FEDERAL HWY
LAKE WORTH FL
33460-3403
US

IV. Provider business mailing address

2007 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6501
US

V. Phone/Fax

Practice location:
  • Phone: 888-400-1556
  • Fax:
Mailing address:
  • Phone: 561-420-8555
  • Fax: 888-442-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME32575
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number32575
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME32575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: