Individual
DR. TIMOTHY D COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 NORTH MAIN, HARRISON, AR 72601-2926
(870) 365-2000
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-3500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2011003498
MO
207P00000X
Emergency Medicine Physician
Primary
E-7237
AR
207P00000X
Emergency Medicine Physician
ME137708
FL
208D00000X
General Practice Physician
0101236812
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190603001
—
AR
01
—
51228
AR BLUE CROSS
—
Enumeration date
04/25/2006
Last updated
11/25/2024
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