Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K2959 | TX |
NPI | 1003824632 |
---|---|
Provider Name | Timothy Martindale |
First Address | Waco, TX 76702-0308 |
Second Address | Waco, TX 76712-3928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 06/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00N59X | BLUE CROSS BLUE SHIELD (01) | TX |
040481601 | (05) | TX |
080181687 | MEDICARE RAILROAD (01) | TX |
092314601 | (05) | TX |
8A6564 | BLUE CROSS AND BLUE SHIEL (01) | TX |