Provider Demographics
NPI:1578539805
Name:MORIARTY, TIMOTHY G (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:G
Last Name:MORIARTY
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:PO BOX 9560
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32417
Mailing Address - Country:US
Mailing Address - Phone:850-872-0502
Mailing Address - Fax:850-872-0677
Practice Address - Street 1:221 E 23RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7612
Practice Address - Country:US
Practice Address - Phone:850-872-0502
Practice Address - Fax:850-872-0677
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061983208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370919100Medicaid
FL370919100Medicaid
FLE76816Medicare UPIN