Healthcare Provider Details

I. General information

NPI: 1790778611
Provider Name (Legal Business Name): TERRYL DEWAYNE TIMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENTARA CIR STE 202
WILLIAMSBURG VA
23188-5727
US

IV. Provider business mailing address

500 SENTARA CIR STE 202
WILLIAMSBURG VA
23188-5727
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-9850
  • Fax: 757-345-6659
Mailing address:
  • Phone: 757-984-9850
  • Fax: 757-345-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101041972
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: