Provider Demographics
NPI:1750332821
Name:TIMSON, CHARLES ROGER (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROGER
Last Name:TIMSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110272
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-0004
Mailing Address - Country:US
Mailing Address - Phone:631-560-4114
Mailing Address - Fax:
Practice Address - Street 1:6090 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4401
Practice Address - Country:US
Practice Address - Phone:941-218-2353
Practice Address - Fax:941-666-5585
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151589207Q00000X
NY165264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00982687Medicaid
NYA64227Medicare UPIN
NY00982687Medicaid