Provider Demographics
NPI:1144291527
Name:DUFFIN, TIMOTHY K (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:K
Last Name:DUFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WEATHERLY DR STE 100L
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8958
Mailing Address - Country:US
Mailing Address - Phone:931-553-2800
Mailing Address - Fax:931-553-0664
Practice Address - Street 1:800 WEATHERLY DR STE 100L
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8958
Practice Address - Country:US
Practice Address - Phone:931-553-2800
Practice Address - Fax:931-553-0664
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN268462088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4078772OtherBCBS
3859341Medicare ID - Type Unspecified
G90198Medicare UPIN