1366603748 NPI number — TIMOTHY MARSHALL ILIFF M.D.

Table of content: TIMOTHY MARSHALL ILIFF M.D. (NPI 1366603748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366603748 NPI number — TIMOTHY MARSHALL ILIFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILIFF
Provider First Name:
TIMOTHY
Provider Middle Name:
MARSHALL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ILIFF
Provider Other First Name:
TIMOTHY
Provider Other Middle Name:
MARSHALL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366603748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 AIRPORT BLVD STE B127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-6700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-414-5900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MEMORIAL HOSPITAL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-1787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-414-5900
Provider Business Practice Location Address Fax Number:
251-675-5036
Provider Enumeration Date:
06/19/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD.31599 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD.31599 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 31599 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)