Provider Demographics
NPI:1275575383
Name:FROST, TIMOTHY W (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:FROST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 10TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5012
Mailing Address - Country:US
Mailing Address - Phone:505-437-4533
Mailing Address - Fax:505-437-5009
Practice Address - Street 1:1401 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5012
Practice Address - Country:US
Practice Address - Phone:505-437-4533
Practice Address - Fax:505-437-5009
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201074548OtherPRESBYTERIAN
NM013135OtherBCBS
NM742841473OtherTAX ID
NM44378Medicaid
NM742841473OtherTAX ID