Provider Demographics
NPI:1962865303
Name:NANEY, TIMOTHY DONOVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DONOVAN
Last Name:NANEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-8037
Mailing Address - Country:US
Mailing Address - Phone:818-389-4023
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO ALBUQUERQUE
Practice Address - Street 2:MSC 10 5530 DEPARTMENT OF RADIOLOGY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMTM2022-03012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program