Individual
TIMOTHY JOHN VAN DE LEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17270 SE 109TH TERRACE RD, SUMMERFIELD, FL 34491-9015
(352) 336-0000
Mailing address
4500 W NEWBERRY RD, GAINESVILLE, FL 32607-2245
(352) 336-6000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01066338A
IN
207X00000X
Orthopaedic Surgery Physician
ME133829
FL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
01066338A
IN
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
35.122356
OH
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
ME133829
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000616931
ANTHEM
—
05
—
200961260
—
IN
01
—
P00755860
RAILROAD MEDICARE
—
Enumeration date
09/29/2008
Last updated
10/27/2020
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