Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 15921 | TX |
N | 1223E0200X | Endodontist | DN12164 | FL |
NPI | 1134190515 |
---|---|
Provider Name | Dr. Timothy Charles Kirkpatrick |
First Address | Helotes, TX 78023-4274 |
Second Address | Lackland A F B, TX 78236-9908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 08/07/2007 |