Basic Information
| Provider Information | |||||||||
| NPI: | 1770564395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ILIFF | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9158 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366910158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514600326 | ||||||||
| FaxNumber: | 2514602846 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 SANDPIPER LN | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365264615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514600326 | ||||||||
| FaxNumber: | 2514602846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10759 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009989605 | 05 | AL | MEDICAID | 051514784 | 01 | AL | BCBS OF AL | OTHER | 009937995 | 05 | AL | MEDICAID | 0080180145 | 01 | AL | RR MEDICARE | OTHER | 05158632 | 01 | AL | BCBS OF AL | OTHER | 009926395 | 05 | AL | MEDICAID | 009980670 | 05 | AL | MEDICAID | 009938315 | 05 | AL | MEDICAID | 051527785 | 01 | AL | BCBS OF AL | OTHER | 051514787 | 01 | AL | BCBS OF AL | OTHER | 051519010 | 01 | AL | BCBS OF AL | OTHER |