Provider Demographics
NPI:1568447944
Name:STOCK, TIMOTHY T (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:T
Last Name:STOCK
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 1:4600 SAMUELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-6874
Mailing Address - Country:US
Mailing Address - Phone:214-275-8500
Mailing Address - Fax:214-388-3800
Practice Address - Street 1:4600 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6874
Practice Address - Country:US
Practice Address - Phone:214-275-8500
Practice Address - Fax:214-388-3800
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK57052084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43586Medicare UPIN
TX8D5696Medicare ID - Type Unspecified