Healthcare Provider Details

I. General information

NPI: 1740317338
Provider Name (Legal Business Name): TIMOTHY S. HONIGMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LSU STUDENT HEALTH CTR INFIRMARY ROAD
BATON ROUGE LA
70803-0001
US

IV. Provider business mailing address

LSU STUDENT HEALTH CTR INFIRMARY ROAD
BATON ROUGE LA
70803-0001
US

V. Phone/Fax

Practice location:
  • Phone: 225-578-6271
  • Fax: 225-578-5282
Mailing address:
  • Phone: 225-578-6271
  • Fax: 225-578-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number016634
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: