Provider Demographics
NPI:1922009380
Name:TIMMS, STEPHEN RAY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RAY
Last Name:TIMMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 MEDICAL PARK
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-243-8399
Mailing Address - Fax:304-243-7189
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:SUITE 303
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3823
Practice Address - Country:US
Practice Address - Phone:304-243-8399
Practice Address - Fax:304-243-7189
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV178382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5503570579J41OtherANTHEM BCBS
234407OtherBLACK LUNG
OH0977813Medicaid
17838AOtherHEALTH PLAN OF UPPER OH V
WV0090236000Medicaid
000603669OtherMOUNTAIN STATE BCBS
WV55035705705OtherWV COMPENSATION
OH0763823Medicare PIN
OH4173851Medicare PIN
234407OtherBLACK LUNG
WV0090236000Medicaid
17838AOtherHEALTH PLAN OF UPPER OH V
5503570579J41OtherANTHEM BCBS
OH0977813Medicaid
OHH421750Medicare PIN