Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 16616 | MS |
Y | 207PE0004X | Emergency Medical Services | N4500 | TX |
NPI | 1033196043 |
---|---|
Provider Name | Dr. Timothy R Jones |
First Address | Fort Worth, TX 76104-4110 |
Second Address | Fort Worth, TX 76104-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H10830 | (02) | MS |