Provider Demographics
NPI:1558470500
Name:REAL, TIMOTHY H (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:H
Last Name:REAL
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 1:4704 CAHABA RIVER RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2344
Mailing Address - Country:US
Mailing Address - Phone:205-313-6894
Mailing Address - Fax:205-313-6897
Practice Address - Street 1:4704 CAHABA RIVER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2344
Practice Address - Country:US
Practice Address - Phone:205-313-6894
Practice Address - Fax:205-313-6897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine