Provider Demographics
NPI:1700033743
Name:NIACARIS, TIMOTHY R (MD, PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:NIACARIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W RANDOL MILL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2579
Mailing Address - Country:US
Mailing Address - Phone:682-212-9190
Mailing Address - Fax:682-212-0150
Practice Address - Street 1:902 W RANDOL MILL RD STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2579
Practice Address - Country:US
Practice Address - Phone:682-212-9190
Practice Address - Fax:682-212-0150
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9755207XS0106X, 207XS0106X
CAA95129207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CW354OtherBCBS
TXP00998012OtherRAILROAD MEDICARE
TX285356601Medicaid
TX8CW354OtherBCBS