MEDICARE: DR. ROBERTS EDGAR TIMBERLAKE JR. 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	208000000X	Pediatrics Physician	33759	NC

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	:	1821071531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTS EDGAR TIMBERLAKE JR. MD

Provider Business Mailing Address
First Line	:	229 NC HIGHWAY 47
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-8601
Country	:	US
Telephone Number	:	336-250-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	741 VINEYARDS XING
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-2076
Country	:	US
Telephone Number	:	336-300-8594
Fax Number	:

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	07/01/2013

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