Provider Demographics
NPI:1225118748
Name:OPPERMANN, TIMOTHY E (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:OPPERMANN
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 1:16605 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3501
Mailing Address - Country:US
Mailing Address - Phone:281-275-0860
Mailing Address - Fax:281-275-0861
Practice Address - Street 1:16605 SOUTHWEST FWY
Practice Address - Street 2:SUITE 450
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3501
Practice Address - Country:US
Practice Address - Phone:281-275-0860
Practice Address - Fax:281-275-0861
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427279207RC0000X
TXM9556208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BC028OtherBCBS
TX196641803Medicaid
TX196641801Medicaid
TX8DZ022OtherBCBS
TX196641804Medicaid
TX8BC028OtherBLUE CROSS BLUE SHIELD
TXTXB145741Medicare PIN
8L0309Medicare PIN
TX8BC028OtherBCBS
TX8BC028OtherBLUE CROSS BLUE SHIELD
TX196641801Medicaid
TX8L12806Medicare PIN
TX540214ZSWDMedicare PIN