Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | A10471 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | N4175 | TX |
NPI | 1285872143 |
---|---|
Provider Name | Timothy Patrick Vachris |
First Address | Austin, TX 78705-2655 |
Second Address | Austin, TX 78705-2655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 04/03/2011 |