Provider Demographics
NPI:1427039627
Name:TIMKEN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:TIMKEN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3131 NW 13TH STREET
Mailing Address - Street 2:SUITE 41
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2163
Mailing Address - Country:US
Mailing Address - Phone:352-226-8206
Mailing Address - Fax:352-240-6759
Practice Address - Street 1:3131 NW 13TH STREET
Practice Address - Street 2:SUITE 41
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2163
Practice Address - Country:US
Practice Address - Phone:352-226-8206
Practice Address - Fax:352-240-6759
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00678092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27852OtherBCBS
FL379383400Medicaid
FL379383400Medicaid
FL27852OtherBCBS
FL27852QMedicare PIN