Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0022906 | TX |
NPI | 1033266549 |
---|---|
Provider Name | Dr. Timothy A. Lew |
First Address | Fort Worth, TX 76244-9059 |
Second Address | Fort Worth, TX 76244-9059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 16/03/2021 |