Provider Demographics
NPI:1598867350
Name:SKELTON, TIMOTHY BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BENJAMIN
Last Name:SKELTON
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 550
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0550
Mailing Address - Country:US
Mailing Address - Phone:228-702-3020
Mailing Address - Fax:228-702-3025
Practice Address - Street 1:147 REYNOIR ST STE 205
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4109
Practice Address - Country:US
Practice Address - Phone:228-702-3020
Practice Address - Fax:228-702-3025
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS20528OtherMISSISSIPPI STATE BOARD OF MEDICAL LICENSURE