Healthcare Provider Details

I. General information

NPI: 1427030931
Provider Name (Legal Business Name): TIMOTHY SCOTT PRINCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2429 DOUBLETREE CT
LEXINGTON KY
40514-1465
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number28223
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: