Provider Demographics
NPI:1194993659
Name:BRUCE I TIMINS MD PA
Entity type:Organization
Organization Name:BRUCE I TIMINS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:727-848-3761
Mailing Address - Street 1:PO BOX 1976
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1976
Mailing Address - Country:US
Mailing Address - Phone:239-303-2640
Mailing Address - Fax:239-303-2981
Practice Address - Street 1:1154 LEE BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4852
Practice Address - Country:US
Practice Address - Phone:239-303-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 36915207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066515100Medicaid
FL95639Medicare PIN