Provider Demographics
NPI:1508948498
Name:VOLM, TIMOTHY GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GERARD
Last Name:VOLM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9572
Mailing Address - Country:US
Mailing Address - Phone:641-472-4141
Mailing Address - Fax:641-469-3516
Practice Address - Street 1:2000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-9572
Practice Address - Country:US
Practice Address - Phone:641-472-4141
Practice Address - Fax:641-469-3516
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28104OtherBLUECROSSBLUE SHIELD
IA1417675Medicaid
IA1417675Medicaid
IAI18578Medicare PIN