Provider Demographics
NPI:1295768398
Name:DEARDOURFF TIMMONS & ASSOCIATES PA
Entity type:Organization
Organization Name:DEARDOURFF TIMMONS & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-2332
Mailing Address - Street 1:6420 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4203
Mailing Address - Country:US
Mailing Address - Phone:352-331-2332
Mailing Address - Fax:352-331-6515
Practice Address - Street 1:6420 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4203
Practice Address - Country:US
Practice Address - Phone:352-331-2332
Practice Address - Fax:352-331-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79809208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71048OtherBCBS PROVIDER NUMBER
FL260934700Medicaid
FL53219OtherBCBS PROVIDER NUMBER
FL51898OtherBCBS PROVIDER NUMBER
FL01228OtherBCBS PROVIDER NUMBER
FL00815Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL53219OtherBCBS PROVIDER NUMBER
FLH35581Medicare UPIN