Provider Demographics
NPI:1770564395
Name:ILIFF, TIMOTHY M (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:ILIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9158
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-0158
Mailing Address - Country:US
Mailing Address - Phone:251-460-0326
Mailing Address - Fax:251-460-2846
Practice Address - Street 1:602 SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4615
Practice Address - Country:US
Practice Address - Phone:251-460-0326
Practice Address - Fax:251-460-2846
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10759207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051519010OtherBCBS OF AL
AL051514784OtherBCBS OF AL
AL009937995Medicaid
AL051514787OtherBCBS OF AL
AL0080180145OtherRR MEDICARE
AL009926395Medicaid
AL009938315Medicaid
AL051527785OtherBCBS OF AL
AL05158632OtherBCBS OF AL
AL009980670Medicaid
AL009989605Medicaid