Provider Demographics
NPI:1770720955
Name:CHURCH, TIMOTHY S (MD, MPH, PHD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:CHURCH
Suffix:
Gender:M
Credentials:MD, MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4124
Mailing Address - Country:US
Mailing Address - Phone:225-763-2632
Mailing Address - Fax:225-763-3014
Practice Address - Street 1:6400 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4124
Practice Address - Country:US
Practice Address - Phone:225-763-2632
Practice Address - Fax:225-763-3014
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.12793R1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA33934OtherLA BOARD OF PHARMACY
LABC6148503OtherLA CONTROLLED SUBSTANCE/REGULATED CHEMICAL LICENSE