Healthcare Provider Details

I. General information

NPI: 1982609921
Provider Name (Legal Business Name): TIMOTHY CHARLES CHILDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 ORANGE AVE
WINTER PARK FL
32789-4907
US

IV. Provider business mailing address

1181 ORANGE AVE
WINTER PARK FL
32789-4907
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-1331
  • Fax: 407-571-2757
Mailing address:
  • Phone: 407-647-1331
  • Fax: 407-571-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME73071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: