MEDICARE: DR. TERRYL DEWAYNE TIMES 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	208600000X	Surgery Physician	0101041972	VA

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

General Provider Information

NPI Number	:	1790778611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRYL DEWAYNE TIMES MD

Provider Business Mailing Address
First Line	:	500 SENTARA CIR STE 202
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5727
Country	:	US
Telephone Number	:	757-984-9850
Fax Number	:	757-345-6659

Provider Business Practice Location Address
First Line	:	500 SENTARA CIR STE 202
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5727
Country	:	US
Telephone Number	:	757-984-9850
Fax Number	:	757-345-6659

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/03/2024

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