Provider Demographics
NPI:1750301446
Name:KREMER, TIMOTHY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:KREMER
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 1:317 E OVILLA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3833
Mailing Address - Country:US
Mailing Address - Phone:469-506-1671
Mailing Address - Fax:
Practice Address - Street 1:317 E OVILLA RD STE 200
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3833
Practice Address - Country:US
Practice Address - Phone:469-506-1671
Practice Address - Fax:833-933-0652
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00593207V00000X
TXL7784207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AA716OtherBCBS
TXP00803267OtherRAILROAD MEDICARE
TX196074201Medicaid
TXP00803267OtherRAILROAD MEDICARE