Provider Demographics
NPI:1780613315
Name:MEYER, TIM (PA)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1129
Mailing Address - Country:US
Mailing Address - Phone:936-546-3810
Mailing Address - Fax:936-546-3816
Practice Address - Street 1:1050 E LOOP 304 STE 200
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1800
Practice Address - Country:US
Practice Address - Phone:936-594-5132
Practice Address - Fax:936-544-3795
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF80869Medicare UPIN