Provider Demographics
NPI:1720376247
Name:TUDOR, TIMOTHY SETH (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SETH
Last Name:TUDOR
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:12920 US HIGHWAY 1
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3772
Mailing Address - Country:US
Mailing Address - Phone:772-228-9808
Mailing Address - Fax:772-228-9844
Practice Address - Street 1:12920 US HIGHWAY 1
Practice Address - Street 2:SUITE 2
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3772
Practice Address - Country:US
Practice Address - Phone:772-228-9808
Practice Address - Fax:772-228-9844
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2016-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 13941207YS0123X
MO2011017333207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery