Provider Demographics
NPI:1417394255
Name:MONTALVO, TIMOTHY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAY
Last Name:MONTALVO
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 1:350 APPALOOSA LN
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-3458
Mailing Address - Country:US
Mailing Address - Phone:972-825-7449
Mailing Address - Fax:
Practice Address - Street 1:350 APPALOOSA LN
Practice Address - Street 2:
Practice Address - City:CHINA SPRING
Practice Address - State:TX
Practice Address - Zip Code:76633-3458
Practice Address - Country:US
Practice Address - Phone:972-825-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10047206390200000X
TXQ7085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program