Healthcare Provider Details

I. General information

NPI: 1437153061
Provider Name (Legal Business Name): ROBERT E TIMBERLAKE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 COURT STREET
PLYMOUTH MA
02360
US

IV. Provider business mailing address

147 COURT STREET
PLYMOUTH MA
02360
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-6710
  • Fax: 508-830-1117
Mailing address:
  • Phone: 508-746-6710
  • Fax: 508-830-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: