Provider Demographics
NPI:1508960238
Name:TESI, TIMOTHY ORLANDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ORLANDO
Last Name:TESI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E HUNT HWY STE 16 BOX 103
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143
Mailing Address - Country:US
Mailing Address - Phone:903-756-5540
Mailing Address - Fax:903-756-5748
Practice Address - Street 1:116 N VALE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-2256
Practice Address - Country:US
Practice Address - Phone:903-665-3339
Practice Address - Fax:903-756-5748
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092782402Medicaid
TX1287790001Medicare NSC
TX092782402Medicaid
TX00F80CMedicare PIN