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General NPI Number Information
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NPI Number | 1851540785
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Entity Type | Organization
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Legal Business Name | TIMOTHY W VALK MD PA
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 103 FRONT ST
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City | PALM COAST
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State | FL
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Zip | 32137-1460
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Country | US
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Telephone | 386-774-5211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 741240
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City | ORANGE CITY
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State | FL
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Zip | 32774-1240
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Country | US
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Telephone | 386-774-5211
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Fax | 386-774-5251
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Authorized Official
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Title or Position | AGENT
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Name | ROBERT C COOLIDGE
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Credential |
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Telephone | 386-774-5211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME36924
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License Number State | FL
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