Provider Demographics
NPI:1295981538
Name:HILL, TIMOTHY (IDC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 BIRKHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-2565
Mailing Address - Country:US
Mailing Address - Phone:210-295-4854
Mailing Address - Fax:210-295-4895
Practice Address - Street 1:3851 ROGER BROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:FT. SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-295-4854
Practice Address - Fax:210-295-4895
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman