Basic Information
| Provider Information | |||||||||
| NPI: | 1326095332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIMMERMAN | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 W 22ND ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053283840 | ||||||||
| FaxNumber: | 6053283841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1508 W 22ND ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053283840 | ||||||||
| FaxNumber: | 6053283841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 41253 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2787 | SD | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.