Provider Demographics
NPI:1578759965
Name:BAINUM, TIMOTHY EWING (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EWING
Last Name:BAINUM
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 1:2673 HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-8750
Mailing Address - Country:US
Mailing Address - Phone:870-356-4240
Mailing Address - Fax:870-356-4250
Practice Address - Street 1:2673 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-8750
Practice Address - Country:US
Practice Address - Phone:870-356-4240
Practice Address - Fax:870-356-4250
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-5630207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine