Provider Demographics
NPI:1437520509
Name:FORNESS, TIMOTHY JOSEEPH (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEEPH
Last Name:FORNESS
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 1:3802 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4755
Mailing Address - Country:US
Mailing Address - Phone:561-386-9211
Mailing Address - Fax:
Practice Address - Street 1:3802 DOGWOOD AVE
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4755
Practice Address - Country:US
Practice Address - Phone:561-386-9211
Practice Address - Fax:561-622-7694
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71975207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253487800Medicaid
FL253487800Medicaid
FL41365AMedicare PIN