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General NPI Number Information
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NPI Number | 1033171665
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Entity Type | Individual
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Provider Name | TIMOTHY METRO TOKER LAT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 311 S LOVERS LN
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City | GATESVILLE
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State | TX
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Zip | 76528-1814
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Country | US
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Telephone | 254-865-8281
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PAMELA DR
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City | GATESVILLE
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State | TX
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Zip | 76528-2834
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Country | US
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Telephone | 254-865-6105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AT2083
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License Number State | TX
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