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NPI Code Detail

MEDICARE: DR. TIMOTHY JAY BILBRUCK M.D.

MEDICARE: DR. TIMOTHY JAY BILBRUCK M.D.
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
12084P0800XPsychiatry Physician55557TN
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1780942854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY JAY BILBRUCK M.D.
Provider Business Mailing Address
First Line : 3587 SOUTHWOOD AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-6149
Country : US
Telephone Number : 501-940-8456
Fax Number :
Provider Business Practice Location Address
First Line : 2911 BRUNSWICK RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38133-4105
Country : US
Telephone Number : 901-377-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2012
Last Update Date : 12/02/2025

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