Provider Demographics
NPI:1417154626
Name:TUAMOKUMO, TIMI SENA-KOLA (MD)
Entity type:Individual
Prefix:DR
First Name:TIMI
Middle Name:SENA-KOLA
Last Name:TUAMOKUMO
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 1:3410 98TH ST STE 4-143
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3847
Mailing Address - Country:US
Mailing Address - Phone:352-246-6385
Mailing Address - Fax:806-853-8572
Practice Address - Street 1:4003 113TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423
Practice Address - Country:US
Practice Address - Phone:352-246-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN11559207R00000X
TXN8864208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282249601Medicaid
TX196491100OtherFIRSTCARE
NM31100732Medicaid
TX8CV647OtherBCBS
TX282249601Medicaid