Provider Demographics
NPI:1225022015
Name:KOSMATKA, TIMOTHY JON (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:KOSMATKA
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 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:8542 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1241
Practice Address - Country:US
Practice Address - Phone:210-616-7300
Practice Address - Fax:210-616-7359
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG87469Medicare UPIN
TX301886YNA7Medicare PIN
VAD000Medicare UPIN