Provider Demographics
NPI: | 1033375597 |
---|---|
Name: | TIMONEY, PETER JOHN (MBBCH) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PETER |
Middle Name: | JOHN |
Last Name: | TIMONEY |
Suffix: | |
Gender: | M |
Credentials: | MBBCH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 110 CONN TERRACE |
Mailing Address - Street 2: | SUITE 550 |
Mailing Address - City: | LEXINGTON |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40508 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-323-5867 |
Mailing Address - Fax: | 859-323-1122 |
Practice Address - Street 1: | 110 CONN TER STE 550 |
Practice Address - Street 2: | |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40508-3206 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-323-5867 |
Practice Address - Fax: | 859-323-1122 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-08-04 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01066337 | 207W00000X |
KY | R1169 | 207W00000X |
KY | 42959 | 207WX0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207WX0200X | Allopathic & Osteopathic Physicians | Ophthalmology | Ophthalmic Plastic and Reconstructive Surgery |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 249500D | Medicare PIN |