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General NPI Number Information
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NPI Number | 1407523723
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Entity Type | Individual
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Provider Name | TIMOTHY ELEAM
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Gender | Male
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 1222 COMMERCE ST APT 2317
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City | DALLAS
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State | TX
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Zip | 75202-4383
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Country | US
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Telephone | 225-220-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 1222 COMMERCE ST APT 2317
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City | DALLAS
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State | TX
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Zip | 75202-4383
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Country | US
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Telephone | 225-220-3820
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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 | 344600000X
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Taxonomy Name | Taxi
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License Number | 44563564
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 44563564
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License Number State | TX
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