Provider Demographics
NPI:1235402736
Name:TIMOTHY J. DEAHL M.D.,P.A.
Entity Type:Organization
Organization Name:TIMOTHY J. DEAHL M.D.,P.A.
Other - Org Name:TIMOTHY J. DEAHL M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-291-2557
Mailing Address - Street 1:260 IH 45 S
Mailing Address - Street 2:STE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4968
Mailing Address - Country:US
Mailing Address - Phone:936-291-2557
Mailing Address - Fax:936-291-2688
Practice Address - Street 1:260 IH 45 S
Practice Address - Street 2:STE B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4968
Practice Address - Country:US
Practice Address - Phone:936-291-2557
Practice Address - Fax:936-291-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131686101Medicaid
TX131686101Medicaid