Provider Demographics
NPI:1720376247
Name:TUDOR, TIMOTHY SETH (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SETH
Last Name:TUDOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1801 SE HILLMOOR DR STE B-105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-398-9911
Mailing Address - Fax:772-398-4577
Practice Address - Street 1:1801 SE HILLMOOR DR STE B-105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:772-398-9911
Practice Address - Fax:772-398-4577
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017333207YS0123X
FLOS 13941207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery