Provider Demographics
NPI:1710480041
Name:KEIDEL, TIMOTHY SCOTT JR (DO)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:KEIDEL
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:KEIDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2120 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7765
Mailing Address - Country:US
Mailing Address - Phone:352-732-5042
Mailing Address - Fax:527-326-0313
Practice Address - Street 1:2120 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7765
Practice Address - Country:US
Practice Address - Phone:352-732-5042
Practice Address - Fax:352-732-6031
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20246207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck