Provider Demographics
NPI:1851302798
Name:METCALF, TIMOTHY S (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:S
Last Name:METCALF
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 1:828 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5073
Mailing Address - Country:US
Mailing Address - Phone:512-878-0533
Mailing Address - Fax:
Practice Address - Street 1:18626 HARDY OAK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4228
Practice Address - Country:US
Practice Address - Phone:210-495-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04906363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical