Provider Demographics
NPI:1669409793
Name:ABIGAIL, TIMOTHY CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:ABIGAIL
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 1:3201 E PRESIDENT GEORGE BUSH HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3566
Mailing Address - Country:US
Mailing Address - Phone:214-217-3668
Mailing Address - Fax:
Practice Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3566
Practice Address - Country:US
Practice Address - Phone:214-217-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT81819Medicare UPIN
TX892690NMedicare ID - Type Unspecified