Provider Demographics
NPI:1730186610
Name:COLGAN, TIMOTHY KELLY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KELLY
Last Name:COLGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4356 DEPT 2234
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:409-236-4900
Mailing Address - Fax:409-236-4901
Practice Address - Street 1:755 N 11TH ST STE P2280
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1525
Practice Address - Country:US
Practice Address - Phone:409-236-4900
Practice Address - Fax:409-236-4901
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2016-0640207RI0011X, 207RC0000X
TXG2674207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080142501Medicaid
TX115955005Medicaid
TX8K3783Medicare PIN
TXB21933Medicare UPIN
TX115955005Medicaid