Provider Demographics
NPI:1184676132
Name:WILLINGHAM, TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:WILLINGHAM
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 1:4611 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4637
Mailing Address - Country:US
Mailing Address - Phone:561-408-9444
Mailing Address - Fax:561-689-7500
Practice Address - Street 1:4611 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4637
Practice Address - Country:US
Practice Address - Phone:561-408-9444
Practice Address - Fax:561-689-7500
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51864OtherBCBS
FL270551600Medicaid
FL270551600Medicaid
FL51864RMedicare PIN