Basic Information
| Provider Information | |||||||||
| NPI: | 1982684098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HLAVINKA | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7909 FREDERICKSBURG RD | ||||||||
| Address2: | SUITE#110 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106144544 | ||||||||
| FaxNumber: | 2106793724 | ||||||||
| Practice Location | |||||||||
| Address1: | 7909 FREDERICKSBURG RD | ||||||||
| Address2: | SUITE #135 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106144544 | ||||||||
| FaxNumber: | 2106793724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G8179 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 129317702 | 05 | TX | MEDICAID |