Healthcare Provider Details

I. General information

NPI: 1275796765
Provider Name (Legal Business Name): TIMOTHY CHARLES EPTING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 GUNN HWY
TAMPA FL
33625-4013
US

IV. Provider business mailing address

13020 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0925
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax: 813-558-6187
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS11197
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS013921
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: