Provider Demographics
NPI:1437138229
Name:LAMASTER, TIMOTHY SCOTT (M D)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:LAMASTER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2110
Mailing Address - Country:US
Mailing Address - Phone:218-728-2210
Mailing Address - Fax:
Practice Address - Street 1:26 E SUPERIOR ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2124
Practice Address - Country:US
Practice Address - Phone:218-249-4300
Practice Address - Fax:218-249-4350
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN637318600Medicaid
MN89005586Medicare ID - Type Unspecified
MNG11184Medicare UPIN