Provider Demographics
NPI:1952347106
Name:LYDA, TIMOTHY STUART (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STUART
Last Name:LYDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:730 N HOUSTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4132
Practice Address - Country:US
Practice Address - Phone:830-620-4540
Practice Address - Fax:830-620-4991
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7080208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123452806Medicaid
TX1G7419OtherMEDICARE