Provider Demographics
NPI:1962453480
Name:QUINN, TIMOTHY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:QUINN
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:PO BOX 162264
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2264
Mailing Address - Country:US
Mailing Address - Phone:941-792-2020
Mailing Address - Fax:239-348-4203
Practice Address - Street 1:4101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:941-792-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47076207W00000X
FLME119496207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110972600Medicaid
MNP00141724OtherMEDICARE RR
FLG21123Medicare UPIN
MNP00141724OtherMEDICARE RR
MNG21123Medicare UPIN