Healthcare Provider Details

I. General information

NPI: 1912122128
Provider Name (Legal Business Name): TIMOTHY S SCHUSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 TRUMAN ST NE
ALBUQUERQUE NM
87110-6443
US

IV. Provider business mailing address

617 TRUMAN ST NE
ALBUQUERQUE NM
87110-6443
US

V. Phone/Fax

Practice location:
  • Phone: 505-366-2400
  • Fax: 505-262-2429
Mailing address:
  • Phone: 505-366-2400
  • Fax: 505-262-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number68170
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: