Provider Demographics
NPI:1467430181
Name:HORRIGAN, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:HORRIGAN
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 1:217 20TH ST NW
Mailing Address - Street 2:PO BOX 857
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2017
Mailing Address - Country:US
Mailing Address - Phone:319-352-9500
Mailing Address - Fax:319-352-9509
Practice Address - Street 1:217 20TH ST NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677
Practice Address - Country:US
Practice Address - Phone:319-352-9500
Practice Address - Fax:319-352-9509
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28154207Q00000X
IA24265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080150490OtherRR MEDICARE
IA8023283Medicaid
IA03992Medicare PIN