Provider Demographics
NPI:1104080514
Name:RUTTAN, TIMOTHY KIRK (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KIRK
Last Name:RUTTAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 PHILOMENA ST STE 253
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3210
Mailing Address - Country:US
Mailing Address - Phone:512-324-0150
Mailing Address - Fax:
Practice Address - Street 1:DELL CHILDREN'S EMERGENCY DEPARTMENT
Practice Address - Street 2:4900 MUELLER BLVD
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-324-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5885207PP0204X, 207P00000X
CAA135072207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine