Provider Demographics
NPI:1598873523
Name:MOMANY, TIMOTHY D (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:MOMANY
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 1:603 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-8018
Mailing Address - Country:US
Mailing Address - Phone:319-622-6292
Mailing Address - Fax:319-622-3077
Practice Address - Street 1:505 39TH AVE
Practice Address - Street 2:POB 207
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-8229
Practice Address - Country:US
Practice Address - Phone:319-622-3231
Practice Address - Fax:319-622-3077
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA621301OtherUHC OF THE RIVER VALLEY
IA0036913Medicaid
IA03974OtherWELLMARK BCBS
IA03974Medicare PIN
IA03974OtherWELLMARK BCBS