1225143480 NPI number — TIMOTHY JAMES OLDANI D.P.M.

Table of content: TIMOTHY JAMES OLDANI D.P.M. (NPI 1225143480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225143480 NPI number — TIMOTHY JAMES OLDANI D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLDANI
Provider First Name:
TIMOTHY
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225143480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1836 LACKLAND HILL PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-872-1439
Provider Business Mailing Address Fax Number:
314-810-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 SOUTH NEW BALLAS ROAD
Provider Second Line Business Practice Location Address:
SUITE 7005B
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-8275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-3668
Provider Business Practice Location Address Fax Number:
314-991-3665
Provider Enumeration Date:
08/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  2005026124 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)