Healthcare Provider Details

I. General information

NPI: 1194221069
Provider Name (Legal Business Name): STEVEN ALEXANDER TIJMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 E SOUTHLAKE BLVD STE 100
SOUTHLAKE TX
76092-6465
US

IV. Provider business mailing address

6309 BRAZOS CT
COLLEYVILLE TX
76034-5725
US

V. Phone/Fax

Practice location:
  • Phone: 817-442-9300
  • Fax:
Mailing address:
  • Phone: 512-740-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberU5242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: