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General NPI Number Information
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NPI Number | 1376546572
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Entity Type | Individual
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Provider Name | RUBEN BERROCAL TIMMONS MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 3406 SANTA ROSA DR
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City | GULF BREEZE
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State | FL
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Zip | 32563-5665
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Country | US
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Telephone | 850-462-4544
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Fax | 850-777-3166
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Provider Business Mailing Address
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Address Line | PO BOX 30332
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City | PENSACOLA
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State | FL
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Zip | 32503-1332
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Country | US
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Telephone | 850-462-4544
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Fax | 850-777-3166
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME 42993
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License Number State | FL
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