Individual
TIMOTHY P OLTERSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 6TH AVE, FORT WORTH, TX 76104-4377
(817) 336-4638
(817) 870-0278
Mailing address
1101 6TH AVE, FORT WORTH, TX 76104-4377
(817) 336-4638
(817) 870-0278
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
F8973
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124446902
—
TX
Enumeration date
07/19/2005
Last updated
03/31/2014
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