Provider Demographics
NPI:1033101829
Name:HUGGINS, TIMOTHY LEBRON (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEBRON
Last Name:HUGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 SANTA FE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5858
Mailing Address - Country:US
Mailing Address - Phone:817-341-3300
Mailing Address - Fax:817-341-3311
Practice Address - Street 1:1508 SANTA FE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5858
Practice Address - Country:US
Practice Address - Phone:817-341-3300
Practice Address - Fax:817-341-3311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2612207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171261401Medicaid
TXE68296Medicare UPIN