Healthcare Provider Details

I. General information

NPI: 1689059271
Provider Name (Legal Business Name): ROGER TIMMS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SENN DR
AKRON OH
44319-1541
US

IV. Provider business mailing address

PO BOX 448
AKRON OH
44309-0448
US

V. Phone/Fax

Practice location:
  • Phone: 330-786-5623
  • Fax:
Mailing address:
  • Phone: 330-786-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRN526694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: