Provider Demographics
NPI:1376546572
Name:TIMMONS, RUBEN BERROCAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:BERROCAL
Last Name:TIMMONS
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:PO BOX 30332
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1332
Mailing Address - Country:US
Mailing Address - Phone:850-462-4544
Mailing Address - Fax:850-777-3166
Practice Address - Street 1:3406 SANTA ROSA DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-5665
Practice Address - Country:US
Practice Address - Phone:850-462-4544
Practice Address - Fax:850-777-3166
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42993208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043027700Medicaid
FLD53367Medicare UPIN
FL17656YMedicare PIN