Individual
DR. TIM IOANNIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
140 SW CHAMBER CT, SUITE 200, PORT SAINT LUCIE, FL 34986-3496
(772) 878-3376
(772) 879-9970
Mailing address
140 SW CHAMBER CT, SUITE 200, PORT SAINT LUCIE, FL 34986-3496
(772) 878-3376
(772) 879-9970
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0073425
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070012925
RR MEDICARE
FL
01
—
44579
BCBS
FL
Enumeration date
05/02/2006
Last updated
07/08/2007
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