Provider Demographics
NPI:1487857660
Name:MCEVOY, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:MCEVOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:P
Other - Last Name:MCEVOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:525 OAK CENTRE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3945
Mailing Address - Country:US
Mailing Address - Phone:210-890-5444
Mailing Address - Fax:210-593-3099
Practice Address - Street 1:525 OAK CENTRE DR STE 350
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3945
Practice Address - Country:US
Practice Address - Phone:210-890-5444
Practice Address - Fax:210-593-3099
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6677207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324267904Medicaid
TX324267905Medicaid
TX324267901Medicaid