Healthcare Provider Details

I. General information

NPI: 1104080514
Provider Name (Legal Business Name): TIMOTHY KIRK RUTTAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 05/06/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DELL CHILDREN'S EMERGENCY DEPARTMENT 4900 MUELLER BLVD
AUSTIN TX
78723
US

IV. Provider business mailing address

1345 PHILOMENA ST STE 253
AUSTIN TX
78723-3210
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9725
  • Fax:
Mailing address:
  • Phone: 512-324-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP5885
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberP5885
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: