Provider Demographics
NPI:1568677524
Name:MARTIN, TIMOTHY BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRUCE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CALYPSO SHRS
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5309
Mailing Address - Country:US
Mailing Address - Phone:415-884-0230
Mailing Address - Fax:
Practice Address - Street 1:20 CALYPSO SHRS
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5309
Practice Address - Country:US
Practice Address - Phone:415-884-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine