Healthcare Provider Details

I. General information

NPI: 1871601286
Provider Name (Legal Business Name): TIMOTHY ALLEN VISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 CHAMBLISS AVENUE
CLEVELAND TN
37320-5030
US

IV. Provider business mailing address

2414 CHAMBLISS AVE NW PO BOX 5030
CLEVELAND TN
37311-3879
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-6581
  • Fax: 423-472-2425
Mailing address:
  • Phone: 434-472-6581
  • Fax: 423-472-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number21512
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: