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General NPI Number Information
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NPI Number | 1396904496
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Entity Type | Organization
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Legal Business Name | TIMKEN RADIOLOGY PA
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 200 N ORLANDO AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-3666
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Country | US
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Telephone | 407-622-9306
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Fax | 407-622-9308
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Provider Business Mailing Address
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Address Line | PO BOX 1814
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City | WINDERMERE
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State | FL
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Zip | 34786-1814
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Country | US
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Telephone | 407-622-9306
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Fax | 407-622-9308
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK J TIMKEN
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Credential | MD
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Telephone | 407-622-9306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | FLME67809
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License Number State | FL
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