Jessie, Timothy Antonio
Jessie, Timothy Antonio is an sole proprietor health care provider with primary practice located at 105 Mills Ave Ste 200 , Las Vegas NM 87701-4169. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Jessie, Timothy Antonio can be contacted via phone (505) 426-3795.Contact Information
Primary practice address
105 Mills Ave Ste 200
Las Vegas NM 87701-4169
Phone: (505) 426-3795
Fax: (505) 425-2653
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 200501327 | North Carolina |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 32580 | Kansas |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 35083403 | Ohio |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | D73747 | Maryland |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MD2020-0191 | New Mexico |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 01076415A | Indiana |
Profile Details
| NPI number | 1679573034 |
|---|---|
| LBN Legal business name | Jessie, Timothy Antonio |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Jun 13th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679573034 | NPPES |
| Ohio | MEDICAID | 2501902 | |
| Ohio | MEDICAID | 69777233 | |
| Ohio | Other | 24-46612 | |
| Ohio | Other | P00144471 |
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