Provider Demographics
NPI:1073551420
Name:DZIUK, TIMOTHY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:DZIUK
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:2130 NE LOOP 410 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4660
Practice Address - Country:US
Practice Address - Phone:210-656-7177
Practice Address - Fax:210-656-3687
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH80172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9047OtherBLUE CROSS BLUE SHIELD
TX920006455OtherRAILROAD MEDICARE
TX136082812Medicaid
TX136082814Medicaid
TX136082813Medicaid
TX8R1430OtherBCBS OF TX
TX87698KMedicare PIN
TX136082813Medicaid
TX8J2781Medicare PIN
TX8L14789Medicare PIN
TX8D5768Medicare PIN