Provider Demographics
NPI:1275591273
Name:SIMPLOT, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:SIMPLOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VALLEY WEST DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3902
Mailing Address - Country:US
Mailing Address - Phone:515-223-4368
Mailing Address - Fax:515-453-2368
Practice Address - Street 1:105 VALLEY WEST DR
Practice Address - Street 2:STE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3902
Practice Address - Country:US
Practice Address - Phone:515-223-4368
Practice Address - Fax:515-453-2368
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32861207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190975Medicaid
G41842Medicare UPIN
IA0190975Medicaid