Individual
TIMOTHY DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1136 E GRANDE BLVD, TYLER, TX 75703-3982
(903) 592-5601
Mailing address
6501 FANNIN ST STE NB302, HOUSTON, TX 77030-2703
(713) 798-5106
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
T5094
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2017
Last updated
06/27/2022
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