Individual
TIMOTHY BLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
779 MEDICAL DR STE 2, ENGLEWOOD, FL 34223-3980
(941) 698-6363
(941) 800-5848
Mailing address
779 MEDICAL DR STE 2, ENGLEWOOD, FL 34223-3980
(941) 698-6363
(941) 800-5848
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME107462
FL
208000000X
Pediatrics Physician
Primary
ME107462
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003184600
—
FL
01
—
P00865254
RAILROAD MEDICARE
FL
Enumeration date
10/15/2006
Last updated
07/24/2021
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