Provider Demographics
NPI:1386644227
Name:LEEDS, TIMOTHY GERARD (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:GERARD
Last Name:LEEDS
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 1:640 S 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-2902
Mailing Address - Country:US
Mailing Address - Phone:515-382-5413
Mailing Address - Fax:515-382-7107
Practice Address - Street 1:640 S 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-2902
Practice Address - Country:US
Practice Address - Phone:515-382-5413
Practice Address - Fax:515-382-7107
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-27989207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E92813Medicare UPIN
03633Medicare ID - Type Unspecified
E92813Medicare UPIN