Individual
DR. TIMOTHY DERRICK DO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4689 US HIGHWAY 17, SUITE 11, ORANGE PARK, FL 32003-4831
(904) 269-7007
(866) 264-0529
Mailing address
4689 US HIGHWAY 17, SUITE 11, ORANGE PARK, FL 32003-4831
(904) 269-7007
(866) 264-0529
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
150583
DC
207T00000X
Neurological Surgery Physician
Primary
ME111835
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009327000
—
FL
Enumeration date
11/09/2008
Last updated
01/27/2022
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