MEDICARE: TIMBER CREEK PEDIATRICS INC

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	208000000X	Pediatrics Physician	ME 77161	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770783680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBER CREEK PEDIATRICS INC

Provider Business Mailing Address
First Line	:	15212 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-5518
Country	:	US
Telephone Number	:	407-380-1777
Fax Number	:	407-380-1766

Provider Business Practice Location Address
First Line	:	15212 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-5518
Country	:	US
Telephone Number	:	407-380-1777
Fax Number	:	407-380-1766

Authorized Official
Title or Position	:	CEO
Name	:	AUSTRIA LUBBETT RODRIGUEZ
Credential	:	MD
Telephone Number	:	407-380-1777

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	03/13/2024

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Directions to “TIMBER CREEK PEDIATRICS INC ” Practice Location

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