Provider Demographics
NPI:1316107121
Name:MCNAMARA, TIMOTHY DWAYNE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DWAYNE
Last Name:MCNAMARA
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:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1331
Mailing Address - Country:US
Mailing Address - Phone:870-972-8181
Mailing Address - Fax:870-974-7001
Practice Address - Street 1:1001 W PARKER RD
Practice Address - Street 2:STE B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9582
Practice Address - Country:US
Practice Address - Phone:870-972-8181
Practice Address - Fax:870-974-7001
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE6853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program