Provider Demographics
NPI:1568437077
Name:EVERETT, TIMOTHY MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MATTHEW
Last Name:EVERETT
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 1:1305 SW 19TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3223
Mailing Address - Country:US
Mailing Address - Phone:239-257-7545
Mailing Address - Fax:
Practice Address - Street 1:1305 SW 19TH LN
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3223
Practice Address - Country:US
Practice Address - Phone:239-257-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-18
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine