Provider Demographics
NPI:1366603748
Name:ILIFF, TIMOTHY MARSHALL (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARSHALL
Last Name:ILIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:MARSHALL
Other - Last Name:ILIFF
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6701 AIRPORT BLVD STE B127
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6700
Mailing Address - Country:US
Mailing Address - Phone:251-414-5900
Mailing Address - Fax:
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1787
Practice Address - Country:US
Practice Address - Phone:251-414-5900
Practice Address - Fax:251-675-5036
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31599207R00000X, 208M00000X
AL31599207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I112625Medicare PIN