MEDICARE: TIMOTHY ALLEN VISER 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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	21512	TN

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	:	1871601286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ALLEN VISER MD

Provider Business Mailing Address
First Line	:	2414 CHAMBLISS AVE NW
Second Line	:	PO BOX 5030
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3879
Country	:	US
Telephone Number	:	434-472-6581
Fax Number	:	423-472-2425

Provider Business Practice Location Address
First Line	:	2414 CHAMBLISS AVENUE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320-5030
Country	:	US
Telephone Number	:	423-472-6581
Fax Number	:	423-472-2425

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

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	04/27/2011

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