Provider Demographics
NPI:1881686178
Name:WAX, TIM DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:DAVIS
Last Name:WAX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 30369
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27130-0369
Mailing Address - Country:US
Mailing Address - Phone:336-999-8888
Mailing Address - Fax:336-999-8889
Practice Address - Street 1:105 W 4TH ST STE 600
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3816
Practice Address - Country:US
Practice Address - Phone:336-306-5777
Practice Address - Fax:336-999-8889
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC33929207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86073OtherBCBS OF NC
NC8986073Medicaid
220016574OtherRAILROAD MEDICARE
NC2192815Medicare PIN