Provider Demographics
NPI:1326055435
Name:BLEND, TIMOTHY WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:BLEND
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 1:1911 MANATEE AVE E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1557
Mailing Address - Country:US
Mailing Address - Phone:941-722-5600
Mailing Address - Fax:941-722-5644
Practice Address - Street 1:1911 MANATEE AVE E
Practice Address - Street 2:SUITE 102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1557
Practice Address - Country:US
Practice Address - Phone:941-722-5600
Practice Address - Fax:941-722-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62136207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251611000Medicaid
FL23974OtherBCBS
FL251611000Medicaid
FL23974OtherBCBS