Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1154 | TX |
NPI | 1508960238 |
---|---|
Provider Name | Dr. Timothy Orlando Tesi |
First Address | San Tan Valley, AZ 85143 |
Second Address | Jefferson, TX 75657-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092782402 | (05) | TX |
T89996 | (02) |