Provider Demographics
NPI:1346309085
Name:KERWIN, TIMOTHY L (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:KERWIN
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 1:1205 POCANTICO LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-0923
Mailing Address - Country:US
Mailing Address - Phone:239-300-1911
Mailing Address - Fax:
Practice Address - Street 1:15465 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-6216
Practice Address - Country:US
Practice Address - Phone:239-429-0200
Practice Address - Fax:239-421-8209
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA911892085R0001X
FLME1017142085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8467004OtherCIGNA
FLP01210193OtherRAILROAD MCR
FL1003459OtherWELLCARE
FL319019OtherAVMED
FL9863140OtherAETNA
FL000710000Medicaid
FL10T819OtherHEALTHY KIDS
FLP106298OtherFREEDOM HEALTH
FL319019OtherAVMED