Provider Demographics
NPI:1861424210
Name:DEER, TIMOTHY RAY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:DEER
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 1:400 COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1652
Mailing Address - Country:US
Mailing Address - Phone:304-347-6120
Mailing Address - Fax:304-347-6142
Practice Address - Street 1:400 COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1652
Practice Address - Country:US
Practice Address - Phone:304-347-6120
Practice Address - Fax:304-347-6142
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17647208VP0014X, 207LP2900X
VA0101053793207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011253000OtherMEDICAID GROUP
WV050065406OtherRR MEDICARE
WV1536929OtherUMWA
WV2154530OtherUHC-ANESTHESIA
WV151628500OtherFEDERAL WORKERS COMP
WV3154530OtherUHC-PAIN
WV0060671000Medicaid
OH2038011Medicaid
WV000631228OtherMSBCBS
WVCI5175OtherRR MEDICARE
WV000631228OtherMSBCBS
WV110908OtherCARELINK
WVF79323Medicare UPIN
OH2038011Medicaid
WV000631228OtherMSBCBS
WV0060671000Medicaid