Provider Demographics
NPI:1477843878
Name:TIMM, JEREMY PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PATRICK
Last Name:TIMM
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 1:10215 REAVIS GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7339
Mailing Address - Country:US
Mailing Address - Phone:801-870-7868
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Practice Address - Street 2:30 NORTH 1900 EAST, RM 4C104
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program