Provider Demographics
NPI:1568550887
Name:MARCYES, TIMOTHY EDGAR (PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EDGAR
Last Name:MARCYES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 130459
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0459
Mailing Address - Country:US
Mailing Address - Phone:903-531-2500
Mailing Address - Fax:903-595-3785
Practice Address - Street 1:1814 ROSELAND BLVD
Practice Address - Street 2:SECOND FLOOR, SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4234
Practice Address - Country:US
Practice Address - Phone:903-531-2500
Practice Address - Fax:903-595-3785
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L24750Medicare PIN