Provider Demographics
NPI:1063696128
Name:VOGL, TIMOTHY D (CO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:VOGL
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S VANDEVENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1239
Mailing Address - Country:US
Mailing Address - Phone:314-368-9438
Mailing Address - Fax:
Practice Address - Street 1:615 S VANDEVENTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1239
Practice Address - Country:US
Practice Address - Phone:314-368-9438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter