Provider Demographics
NPI:1417169962
Name:VU, TIM (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:VU
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 1:10628 CULEBRA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1310
Mailing Address - Country:US
Mailing Address - Phone:210-387-3929
Mailing Address - Fax:
Practice Address - Street 1:10628 CULEBRA RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1310
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12938207P00000X
TXP3597207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417169968Medicaid
NVFV1182637OtherDEA
NV12938OtherNV MEDICAL LICENSE
NVCS17711OtherNV PHARMACY CERTIFICATE
NVBJ775ZMedicare PIN
NV1417169968Medicaid
NV12938OtherNV MEDICAL LICENSE