Provider Demographics
NPI:1770653586
Name:TIMMINS, AUDRA E (MD)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:E
Last Name:TIMMINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DRYDEN RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2414
Mailing Address - Country:US
Mailing Address - Phone:713-798-5899
Mailing Address - Fax:713-798-8410
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 1450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-7500
Practice Address - Fax:713-798-3487
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117042503Medicaid
TX8L1468Medicare PIN
TX81207KMedicare PIN
TXH14999Medicare UPIN
TX8658J8Medicare PIN
TXB100233Medicare PIN