Provider Demographics
NPI:1265635098
Name:TIMOTHY S SIGMAN MD PA
Entity Type:Organization
Organization Name:TIMOTHY S SIGMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-388-1161
Mailing Address - Street 1:7965 BAY ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3282
Mailing Address - Country:US
Mailing Address - Phone:772-388-1161
Mailing Address - Fax:772-388-1470
Practice Address - Street 1:7965 BAY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3282
Practice Address - Country:US
Practice Address - Phone:772-388-1161
Practice Address - Fax:772-388-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05066OtherBLUE CROSS
FLME82284OtherLICENSE
FL05066OtherBLUE CROSS
FLE5805Medicare PIN