Healthcare Provider Details

I. General information

NPI: 1124070149
Provider Name (Legal Business Name): ADIN LIM TIMBAYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 WASHINGTON ST
MONTGOMERY WV
25136
US

IV. Provider business mailing address

411 WASHINGTON ST PO BOX 299
MONTGOMERY WV
25136
US

V. Phone/Fax

Practice location:
  • Phone: 304-442-4204
  • Fax: 304-442-4204
Mailing address:
  • Phone: 304-442-4204
  • Fax: 304-442-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11489
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: