Provider Demographics
NPI:1588725931
Name:TIMON, STEPHEN JAY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAY
Last Name:TIMON
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 1:400 W LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-556-2885
Mailing Address - Fax:972-506-8733
Practice Address - Street 1:400 W LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 330
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-556-2885
Practice Address - Fax:972-506-8733
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7224207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R0560Medicaid
TXH94467Medicare UPIN
TX8C9003Medicare ID - Type Unspecified