Healthcare Provider Details

I. General information

NPI: 1285872143
Provider Name (Legal Business Name): TIMOTHY PATRICK VACHRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 RED RIVER ST. SUITE 201 TEXAS SPORTS & FAMILY MEDICINE
AUSTIN TX
78705-2655
US

IV. Provider business mailing address

3200 RED RIVER ST. SUITE 201 TEXAS SPORTS & FAMILY MEDICINE
AUSTIN TX
78705-2655
US

V. Phone/Fax

Practice location:
  • Phone: 512-473-0201
  • Fax: 512-473-0202
Mailing address:
  • Phone: 512-473-0201
  • Fax: 512-473-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberN4175
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA10471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: