Provider Demographics
NPI:1174811772
Name:TIMENY, JOB (DPM)
Entity type:Individual
Prefix:
First Name:JOB
Middle Name:
Last Name:TIMENY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-479-5202
Practice Address - Street 1:11100 SUMMER RIDGE LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4064
Practice Address - Country:US
Practice Address - Phone:239-344-2348
Practice Address - Fax:239-479-5194
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL9559213ES0103X
FLPO3490213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004775300Medicaid
FLGD180ZMedicare PIN