Provider Demographics
NPI:1518226356
Name:WOMBACHER, TIMOTHY P (PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:WOMBACHER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11970 N CENTRAL EXPY STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3784
Mailing Address - Country:US
Mailing Address - Phone:214-575-5885
Mailing Address - Fax:907-782-4662
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:708-783-7025
Practice Address - Fax:708-783-7409
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085005389363AS0400X
TXPA12692363A00000X
IL085.005389363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant