Provider Demographics
NPI:1275638165
Name:LINDAMOOD, TIMOTHY EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EVAN
Last Name:LINDAMOOD
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 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-806-5431
Mailing Address - Fax:760-806-5428
Practice Address - Street 1:130 CEDAR RD # 102
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5102
Practice Address - Country:US
Practice Address - Phone:760-806-5431
Practice Address - Fax:760-806-5428
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64180207RG0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G641800Medicaid
CA00G641800Medicaid
CAE70266Medicare UPIN