MEDICARE: DR. MARK J. TIMKEN 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	2085R0202X	Diagnostic Radiology Physician	ME0067809	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27852	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427039627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. TIMKEN MD

Provider Business Mailing Address
First Line	:	3131 NW 13TH STREET
Second Line	:	SUITE 41
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-2163
Country	:	US
Telephone Number	:	352-226-8206
Fax Number	:	352-240-6759

Provider Business Practice Location Address
First Line	:	3131 NW 13TH STREET
Second Line	:	SUITE 41
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-2163
Country	:	US
Telephone Number	:	352-226-8206
Fax Number	:	352-240-6759

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/04/2014

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