Provider Demographics
NPI:1376182972
Name:CARGLE, TIMOTHY JR
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:CARGLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:CARGLE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3080 ACKERMAN BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3658
Mailing Address - Country:US
Mailing Address - Phone:937-723-7759
Mailing Address - Fax:
Practice Address - Street 1:3080 ACKERMAN BLVD STE 220
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3658
Practice Address - Country:US
Practice Address - Phone:937-723-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20190020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist