Provider Demographics
NPI:1063435758
Name:WHYATT, TIMOTHY J (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:WHYATT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SW 34TH CIR. STE 102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6619
Mailing Address - Country:US
Mailing Address - Phone:352-861-0444
Mailing Address - Fax:352-861-0464
Practice Address - Street 1:3301 SW 34TH CIR. STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6619
Practice Address - Country:US
Practice Address - Phone:352-861-0444
Practice Address - Fax:352-861-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2753213EP1101X
FLPO 2753213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122473900Medicaid
FL390448200Medicaid
FL65590OtherBCBS PROVIDER #
FL0966720001Medicare NSC
FL65590OtherBCBS PROVIDER #