Individual
MR. TIMOTHY ANDREW MARVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
171 ROCK HOUSE DR, LIBERTY HILL, TX 78642-6305
(512) 656-2928
(512) 656-2928
Mailing address
171 ROCK HOUSE DR, LIBERTY HILL, TX 78642-6305
(512) 656-2928
(512) 656-2928
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
F01177
CO
246ZC0007X
Surgical Assistant
Primary
SA00018
TX
246ZS0410X
Surgical Technologist
F01177
CO
246ZS0410X
Surgical Technologist
SA00018
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F01177
CERIFIED FIRST ASSISTANT
CO
01
—
SA00018
LICENSE SURGICAL ASSISTANT
TX
Enumeration date
08/31/2006
Last updated
10/08/2015
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