Provider Demographics
NPI:1255331864
Name:DEAHL, TIMOTHY JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:DEAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:JAMES
Other - Last Name:DEAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:260 IH 45 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4958
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:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4958
Practice Address - Country:US
Practice Address - Phone:936-291-2557
Practice Address - Fax:936-291-2688
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131686101Medicaid
TXE89799Medicare UPIN
TXG66UMedicare ID - Type Unspecified