Provider Demographics
NPI:1336112184
Name:TIMMING, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:TIMMING
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Gender:M
Credentials:MD
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Mailing Address - Street 1:401 PHALEN BLVD
Mailing Address - Street 2:PMR DEPT MS 41104F
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-7760
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41102E
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7760
Practice Address - Fax:651-254-7765
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
MN21315208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN690802100Medicaid
MN690802100Medicaid