Healthcare Provider Details

I. General information

NPI: 1841319142
Provider Name (Legal Business Name): THEODORE TUINSTRA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N COIT RD #2403A
RICHARDSON TX
75080-5416
US

IV. Provider business mailing address

970 N COIT RD #2403A
RICHARDSON TX
75080-5416
US

V. Phone/Fax

Practice location:
  • Phone: 972-437-9772
  • Fax: 972-437-9760
Mailing address:
  • Phone: 972-437-9772
  • Fax: 972-437-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD4576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: