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General NPI Number Information
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NPI Number | 1659564730
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Entity Type | Organization
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Legal Business Name | TIMOTHY E PHELAN, M.D A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 1621 CREEKSIDE DR 102
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City | FOLSOM
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State | CA
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Zip | 95630-3493
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Country | US
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Telephone | 916-984-7428
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Fax | 916-984-0157
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Provider Business Mailing Address
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Address Line | 1621 CREEKSIDE DR 102
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City | FOLSOM
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State | CA
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Zip | 95630-3493
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Country | US
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Telephone | 916-984-7428
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Fax | 916-984-0157
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. TIMOTHY EDWIN PHELAN
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Credential | M.D.
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Telephone | 916-984-7428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G084901
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License Number State | CA
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