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General NPI Number Information
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NPI Number | 1174811772
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Entity Type | Individual
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Provider Name | JOB TIMENY DPM
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Gender | Male
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Dates
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Enumeration Date | 07/16/2011
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 11100 SUMMER RIDGE LN
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City | FORT MYERS
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State | FL
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Zip | 33908-4064
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Country | US
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Telephone | 239-344-2348
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Fax | 239-479-5194
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Provider Business Mailing Address
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Address Line | PO BOX 919771
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City | ORLANDO
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State | FL
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Zip | 32891-0001
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Country | US
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Telephone | 239-278-3600
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Fax | 239-479-5202
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | LL9559
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3490
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License Number State | FL
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