1770564395 NPI number — DR. TIMOTHY M ILIFF MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770564395 NPI number — DR. TIMOTHY M ILIFF MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ILIFF

Provider First Name:

TIMOTHY

Provider Middle Name:

M

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1770564395

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/23/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 9158

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:

36691-0158

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

251-460-0326

Provider Business Mailing Address Fax Number:

251-460-2846

Provider First Line Business Practice Location Address:

602 SANDPIPER LN

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DAPHNE

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

36526-4615

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

251-460-0326

Provider Business Practice Location Address Fax Number:

251-460-2846

Provider Enumeration Date:

11/10/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  10759 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 10759 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 051519010 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 051514784 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009937995 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 051514787 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 0080180145 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009926395 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009938315 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 051527785 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 05158632 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009980670 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009989605 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".