Provider Demographics
NPI:1194722173
Name:OVERLOCK, TIMOTHY L (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:OVERLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 TEXAS BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5107
Mailing Address - Country:US
Mailing Address - Phone:903-794-3701
Mailing Address - Fax:903-794-3518
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-794-3701
Practice Address - Fax:903-794-3518
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG47253Medicare UPIN
TX8F0052Medicare ID - Type Unspecified