Provider Demographics
NPI:1962887943
Name:SELWAY, TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SELWAY
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 1:10441 QUALITY DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-9652
Mailing Address - Country:US
Mailing Address - Phone:352-606-2722
Mailing Address - Fax:352-606-2723
Practice Address - Street 1:10441 QUALITY DR STE 205
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-9652
Practice Address - Country:US
Practice Address - Phone:352-606-2722
Practice Address - Fax:352-606-2723
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067872207R00000X
TXR9859207R00000X
FLME148799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine