Provider Demographics
NPI:1518980754
Name:ROHAM, TIMOTHY O (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:O
Last Name:ROHAM
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 1:629 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2834
Mailing Address - Country:US
Mailing Address - Phone:949-248-1900
Mailing Address - Fax:949-248-1956
Practice Address - Street 1:629 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE # 103
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2834
Practice Address - Country:US
Practice Address - Phone:949-248-1900
Practice Address - Fax:949-248-1956
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8040207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine