Individual
TIMOTHY JAMES IMMONEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-1100
(817) 702-2140
Mailing address
PO BOX 732973, DALLAS, TX 75373-6901
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
34.015859
OH
207VM0101X
Maternal & Fetal Medicine Physician
Primary
5101027095
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/27/2017
Last updated
04/03/2024
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