Provider Demographics
NPI:1952846024
Name:TIMOTHY GLOYD LLC
Entity Type:Organization
Organization Name:TIMOTHY GLOYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-909-9590
Mailing Address - Street 1:2302 SW AVENUE F
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3852
Mailing Address - Country:US
Mailing Address - Phone:832-909-9590
Mailing Address - Fax:713-721-2535
Practice Address - Street 1:2302 SW AVENUE F
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3852
Practice Address - Country:US
Practice Address - Phone:832-909-9590
Practice Address - Fax:713-721-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty