Provider Demographics
NPI:1699877852
Name:RUARK, TIM FRANKLIN JR (MD)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:FRANKLIN
Last Name:RUARK
Suffix:JR
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 1:1401 CENTERVILLE RD STE G02
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4638
Mailing Address - Country:US
Mailing Address - Phone:850-433-1210
Mailing Address - Fax:850-431-2199
Practice Address - Street 1:1401 CENTERVILLE RD STE G02
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4638
Practice Address - Country:US
Practice Address - Phone:850-433-1210
Practice Address - Fax:850-431-2199
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066328208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375634300Medicaid
FLF84806Medicare UPIN
FL375634300Medicaid