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General NPI Number Information
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NPI Number | 1831349679
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN VAN DE LEUR MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 17270 SE 109TH TERRACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9015
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Country | US
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Telephone | 352-336-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 W NEWBERRY RD
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City | GAINESVILLE
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State | FL
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Zip | 32607-2245
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Country | US
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Telephone | 352-336-6000
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME133829
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01066338A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 35.122356
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 01066338A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | ME133829
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License Number State | FL
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