Provider Demographics
NPI:1790866242
Name:CAHILL, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:CAHILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8761 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1106
Mailing Address - Country:US
Mailing Address - Phone:904-641-6628
Mailing Address - Fax:904-642-1243
Practice Address - Street 1:2626 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4402
Practice Address - Country:US
Practice Address - Phone:904-641-6628
Practice Address - Fax:904-642-1243
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400825207P00000X
FLME97443207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278244800Medicaid
FLME0097443OtherSTATE OF FLORIDA WORKERS COMP
FL95655OtherFLORIDA BCBS
FLI47277Medicare UPIN
FL278244800Medicaid
FLAF751ZMedicare PIN