Provider Demographics
NPI:1083855159
Name:GEORGE, TIMOTHY R (EMPA-C)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:GEORGE
Suffix:
Gender:M
Credentials:EMPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23511 HARDY OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-1928
Mailing Address - Country:US
Mailing Address - Phone:210-361-3266
Mailing Address - Fax:
Practice Address - Street 1:23511 HARDY OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-1928
Practice Address - Country:US
Practice Address - Phone:210-361-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03783745Medicaid