Provider Demographics
NPI:1841319142
Name:TUINSTRA, THEODORE (DO)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:TUINSTRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N COIT RD
Mailing Address - Street 2:#2403A
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5416
Mailing Address - Country:US
Mailing Address - Phone:972-437-9772
Mailing Address - Fax:972-437-9760
Practice Address - Street 1:970 N COIT RD
Practice Address - Street 2:#2403A
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5416
Practice Address - Country:US
Practice Address - Phone:972-437-9772
Practice Address - Fax:972-437-9760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97798Medicare UPIN
TX8E0217Medicare ID - Type Unspecified