Provider Demographics
NPI:1043596117
Name:TIMOTHY H REAL MD LLC
Entity Type:Organization
Organization Name:TIMOTHY H REAL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:REAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-313-6894
Mailing Address - Street 1:4704 CAHABA RIVER RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2344
Mailing Address - Country:US
Mailing Address - Phone:205-313-6894
Mailing Address - Fax:205-313-6897
Practice Address - Street 1:4704 CAHABA RIVER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2344
Practice Address - Country:US
Practice Address - Phone:205-313-6894
Practice Address - Fax:205-313-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care