Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | J3635 | TX |
NPI | 1013972173 |
---|---|
Provider Name | Roger Timperlake |
First Address | Corpus Christi, TX 78466-1160 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 10/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138326707 | (05) | TX |
B63882 | (02) |