Provider Demographics
NPI:1043299134
Name:TIMBOL, RANDOLPH N (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:N
Last Name:TIMBOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SW 1ST AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:910 SW 1ST AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-732-5265
Practice Address - Fax:352-732-5372
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41613OtherBCBS
FL253126700Medicaid
FL990010830Medicare PIN
FL41613Medicare PIN
FL253126700Medicaid