Provider Demographics
NPI:1205835451
Name:HILLBRICK, TIMOTHY JOE JR (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOE
Last Name:HILLBRICK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:HILLBRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1507 RIVERY BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3058
Practice Address - Country:US
Practice Address - Phone:512-509-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV962207Q00000X
TXK6467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH20188Medicare UPIN
NV101292Medicare PIN