Basic Information
| Provider Information | |||||||||
| NPI: | 1770552622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIFER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2112 CHERRY VALLEY RD | ||||||||
| Address2: | P O BOX 948 | ||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430580948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405223774 | ||||||||
| FaxNumber: | 7405222221 | ||||||||
| Practice Location | |||||||||
| Address1: | 2112 CHERRY VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405223774 | ||||||||
| FaxNumber: | 7405222221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34.008359 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2594732 | 05 | OH | MEDICAID |