Provider Demographics
NPI:1205814993
Name:ARCHER, TIMOTHY FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:FRANK
Last Name:ARCHER
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 1:3111 MCCANN RD
Mailing Address - Street 2:EMERGENCY ROOM
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603
Mailing Address - Country:US
Mailing Address - Phone:903-753-1212
Mailing Address - Fax:
Practice Address - Street 1:3111 MCCANN RD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-753-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3560207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL3560OtherSTATE LICENCSE
TX153233501Medicaid
TX153233501Medicaid
TXBA7515628OtherDEA #