Provider Demographics
NPI:1376697250
Name:MERGENS, TIMOTHY DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DAN
Last Name:MERGENS
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 1:5704 S 167TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-5361
Mailing Address - Country:US
Mailing Address - Phone:402-445-5569
Mailing Address - Fax:800-289-0610
Practice Address - Street 1:2717 N 118TH CIR
Practice Address - Street 2:300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-9688
Practice Address - Country:US
Practice Address - Phone:402-445-5569
Practice Address - Fax:800-289-0610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18174207R00000X
IA34443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine