Individual
TIMOTHY MICHAEL PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2525 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4710
(904) 388-0704
(904) 387-9095
Mailing address
PO BOX 25317, TAMPA, FL 33622-5317
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME28633
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372361500
—
FL
Enumeration date
04/05/2006
Last updated
02/26/2019
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