Provider Demographics
NPI:1396898334
Name:TIMOTHY R TOWARD DO PA
Entity type:Organization
Organization Name:TIMOTHY R TOWARD DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-845-6960
Mailing Address - Street 1:2730 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4539
Mailing Address - Country:US
Mailing Address - Phone:561-845-6960
Mailing Address - Fax:
Practice Address - Street 1:2730 BROADWAY
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4539
Practice Address - Country:US
Practice Address - Phone:561-845-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO03468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL082998448OtherRAILROAD MEDICARE
FL81950OtherBC BS
FL54883900Medicaid
FL743144882OtherWELLCARE
FL81950Medicare ID - Type Unspecified
FL54883900Medicaid