Provider Demographics
NPI:1659342004
Name:JANZ, TIMOTHY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:JANZ
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 1:522 E MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3875
Mailing Address - Country:US
Mailing Address - Phone:941-637-1119
Mailing Address - Fax:941-637-1739
Practice Address - Street 1:522 E MARION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3875
Practice Address - Country:US
Practice Address - Phone:941-637-1119
Practice Address - Fax:941-637-1739
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51079Medicare UPIN
FL04686ZMedicare ID - Type Unspecified