Provider Demographics
NPI:1881857951
Name:CASPERSON, TIMOTHY (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CASPERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2888
Mailing Address - Country:US
Mailing Address - Phone:936-756-9191
Mailing Address - Fax:936-756-9197
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2888
Practice Address - Country:US
Practice Address - Phone:936-756-9191
Practice Address - Fax:936-756-9197
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1858213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613391Medicare PIN