Basic Information
| Provider Information | |||||||||
| NPI: | 1669433801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STERNBERG | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | LAMON | ||||||||
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| Credential: | M.D., D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 WELLS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320732982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
| FaxNumber: | 9046191080 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 RIVERSIDE AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322058233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042648801 | ||||||||
| FaxNumber: | 9046210566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME69375 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | ME69375 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | ME69375 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00071130 | 01 | FL | RAILROAD MEDICARE | OTHER | 2649501-00 | 05 | FL | MEDICAID | 614436071A | 05 | GA | MEDICAID |