Healthcare Provider Details

I. General information

NPI: 1801231162
Provider Name (Legal Business Name): TIMOTHY PETER WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE 6008
MIAMI FL
33133-4221
US

IV. Provider business mailing address

15051 S TAMIAMI TRL STE 203
FORT MYERS FL
33908-5182
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-6555
  • Fax: 305-856-6556
Mailing address:
  • Phone: 239-437-8810
  • Fax: 239-313-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME132878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: