Provider Demographics
NPI:1710969415
Name:SPENCE, TIMOTHY AARON (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:AARON
Last Name:SPENCE
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 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 205N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1098
Mailing Address - Country:US
Mailing Address - Phone:915-542-2352
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:737-247-7200
Practice Address - Fax:512-406-7368
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049218208000000X
AL00025763208000000X
TXP2534208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302726002Medicaid
TX302726003Medicaid
TX302726001Medicaid
TX302726004Medicaid
TX302726004Medicaid
TX302726003Medicaid
TX302726002Medicaid