Provider Demographics
NPI:1104884410
Name:HESSERT, TIMOTHY R (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:HESSERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5303
Mailing Address - Country:US
Mailing Address - Phone:813-984-8846
Mailing Address - Fax:813-984-8827
Practice Address - Street 1:5001 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5303
Practice Address - Country:US
Practice Address - Phone:813-984-8846
Practice Address - Fax:813-984-8827
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133640208000000X
NY181721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101323DLOtherPREFERRED CARE
NY050915000029OtherFIDELIS
NY00020892902OtherUNIVERA
NYP010181721OtherBLUE CHOICE
NY1292886OtherIHA
NY10511492OtherCAQH
NY00020892902OtherUNIVERA
NY101323DLOtherPREFERRED CARE