Provider Demographics
NPI:1225052681
Name:TIMMERMAN, LAURA A (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N. WIGET LANE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-952-4080
Mailing Address - Fax:925-952-4081
Practice Address - Street 1:230 N. WIGET LANE
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-952-4080
Practice Address - Fax:925-952-4081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG060834207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G608340Medicare ID - Type Unspecified
E81222Medicare UPIN