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General NPI Number Information
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NPI Number | 1750332821
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Entity Type | Individual
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Provider Name | CHARLES ROGER TIMSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 6090 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-4401
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Country | US
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Telephone | 941-218-2353
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Fax | 941-666-5585
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Provider Business Mailing Address
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Address Line | PO BOX 110272
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City | LAKEWOOD RCH
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State | FL
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Zip | 34211-0004
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Country | US
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Telephone | 631-560-4114
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME151589
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 165264
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License Number State | NY
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