Provider Demographics
NPI:1538268461
Name:MISENHEIMER, TIMOTHY JOE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOE
Last Name:MISENHEIMER
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 1:548 GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5573
Mailing Address - Country:US
Mailing Address - Phone:336-629-5989
Mailing Address - Fax:336-629-9868
Practice Address - Street 1:548 GREENSBORO ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5573
Practice Address - Country:US
Practice Address - Phone:336-629-5989
Practice Address - Fax:336-629-9868
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8959547Medicaid
NC26738OtherPARTNERS
NC59547OtherBCBS
NCC0760OtherMEDCOST
NC551574OtherMAMSI
212525FMedicare ID - Type Unspecified
NC26738OtherPARTNERS