Provider Demographics
NPI:1851786727
Name:MANSOUR, TIMOTHY W (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3 MOBILE INFIRMARY CIR STE 212
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3514
Mailing Address - Country:US
Mailing Address - Phone:251-433-2609
Mailing Address - Fax:251-438-9607
Practice Address - Street 1:3 MOBILE INFIRMARY CIR STE 212
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3514
Practice Address - Country:US
Practice Address - Phone:251-433-2609
Practice Address - Fax:251-438-9607
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL35715208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery