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General NPI Number Information
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NPI Number | 1922111780
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Entity Type | Organization
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Legal Business Name | TIMOTHY M KILLOUGH MD PA
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 103 WOODLANE DR
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City | SEARCY
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State | AR
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Zip | 72143
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Country | US
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Telephone | 501-268-3733
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Fax | 501-207-6139
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Provider Business Mailing Address
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Address Line | 103 WOODLANE DR
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City | SEARCY
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State | AR
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Zip | 72143
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Country | US
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Telephone | 501-268-3733
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Fax | 501-207-6139
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | TIMOTHY M KILLOUGH
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Credential | MD
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Telephone | 501-268-3733
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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 | C7302
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License Number State | AR
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