Provider Demographics
NPI:1295396513
Name:TIMMERMEYER, JOSEPH D (SAC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:TIMMERMEYER
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 FOSSIL DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-7452
Mailing Address - Country:US
Mailing Address - Phone:719-321-2622
Mailing Address - Fax:
Practice Address - Street 1:324 FOSSIL DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-7452
Practice Address - Country:US
Practice Address - Phone:719-321-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002530363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty