Provider Demographics
NPI:1376646562
Name:PURSLEY, TIMOTHY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAY
Last Name:PURSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:402 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5907
Mailing Address - Country:US
Mailing Address - Phone:407-628-4312
Mailing Address - Fax:407-628-1845
Practice Address - Street 1:402 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5907
Practice Address - Country:US
Practice Address - Phone:407-628-4312
Practice Address - Fax:407-628-1845
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252196200Medicaid
FLG45921Medicare UPIN
FL28538Medicare PIN