Provider Demographics
NPI:1790761153
Name:OU-TIM, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:OU-TIM
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 1:1010 1ST ST N
Mailing Address - Street 2:STE 301
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8608
Mailing Address - Country:US
Mailing Address - Phone:205-620-8358
Mailing Address - Fax:205-620-8359
Practice Address - Street 1:1010 1ST ST N
Practice Address - Street 2:STE 301
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8608
Practice Address - Country:US
Practice Address - Phone:205-620-8358
Practice Address - Fax:205-620-8359
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10226207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL428400180Medicaid
AL102I109656Medicare PIN
AL428400180Medicaid