Provider Demographics
NPI:1851544712
Name:SAYLES, TIMOTHY LUKE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LUKE
Last Name:SAYLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON STE 180
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2060
Mailing Address - Country:US
Mailing Address - Phone:925-866-1005
Mailing Address - Fax:925-866-1006
Practice Address - Street 1:2301 CAMINO RAMON STE 180
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2060
Practice Address - Country:US
Practice Address - Phone:925-866-1005
Practice Address - Fax:925-866-1006
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05968363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200111701Medicaid
TX200111701Medicaid