MEDICARE: TIMOTHY SCOTT PRINCE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	28223	KY

General Provider Information

NPI Number	:	1427030931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY SCOTT PRINCE MD

Provider Business Mailing Address
First Line	:	2429 DOUBLETREE CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 GREATSTONE PT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3274
Country	:	US
Telephone Number	:	859-257-5150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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