Provider Demographics
NPI:1942449459
Name:TIMOTHY ROBERT WILLINGHAM MD LLC
Entity Type:Organization
Organization Name:TIMOTHY ROBERT WILLINGHAM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-202-5585
Mailing Address - Street 1:649 US HIGHWAY 1
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:649 US HIGHWAY 1
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4600
Practice Address - Country:US
Practice Address - Phone:561-775-6455
Practice Address - Fax:561-775-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270551600Medicaid
FL51864BMedicare PIN
FL270551600Medicaid
FL51864ZMedicare PIN