Provider Demographics
NPI:1457361701
Name:LIDDY, TIMOTHY JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:LIDDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9100 WILSHIRE BLVD.
Mailing Address - Street 2:STE. 503-E
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-652-1163
Mailing Address - Fax:310-652-2713
Practice Address - Street 1:9100 WILSHIRE BLVD.
Practice Address - Street 2:STE. 503-E
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-652-1163
Practice Address - Fax:310-652-2713
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3631213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist