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General NPI Number Information
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NPI Number | 1841220134
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Entity Type | Organization
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Legal Business Name | TIMOTHY C HARRELL, MD, PA
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5700 N FEDERAL HWY SUITE 6
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-2600
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Country | US
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Telephone | 954-776-1190
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Fax | 954-776-1196
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Provider Business Mailing Address
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Address Line | 5700 N FEDERAL HWY SUITE 6
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-2600
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Country | US
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Telephone | 954-776-1190
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Fax | 954-776-1196
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY C HARRELL
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Credential | MD
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Telephone | 954-776-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0024306
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License Number State | FL
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