Individual
DR. TIMOTHY A DILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 BRADEN ST, EMERGENCY DEPT, JACKSONVILLE, AR 72076-3721
(501) 985-7000
Mailing address
PO BOX 3925, SHREVEPORT, LA 71133-3925
(800) 684-0052
(405) 844-1794
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301044283
MI
2086S0129X
Vascular Surgery Physician
T2007-006
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07100015600
QC
AR
05
—
164478001
—
AR
01
—
5086184
AETNA
AR
01
—
786546
HEALTHLINK
AR
01
—
P01027351
RAILROAD MCARD
—
Enumeration date
04/10/2006
Last updated
06/19/2012
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