Individual
DR. TIMOTHY GAMMONS
Active
Individual
DR. TIMOTHY GAMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101013821
MI
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
5101013821
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133449
CARE-PREFERRED CHOICES
MI
05
—
1730163023
—
MI
01
—
700H217350
BLUE SHIELD
MI
01
—
H53730
HAP
MI
Enumeration date
12/01/2005
Last updated
02/26/2018
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