Healthcare Provider Details

I. General information

NPI: 1023758463
Provider Name (Legal Business Name): TIMOTHY LOUIS JALBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5529
US

IV. Provider business mailing address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5529
US

V. Phone/Fax

Practice location:
  • Phone: 937-630-2161
  • Fax:
Mailing address:
  • Phone: 937-630-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.156953.MIL
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: