Provider Demographics
NPI:1598971038
Name:DYGERT, TIMO NIILO (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMO
Middle Name:NIILO
Last Name:DYGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:NIILO
Other - Last Name:DYGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4314
Mailing Address - Country:US
Mailing Address - Phone:541-930-7222
Mailing Address - Fax:
Practice Address - Street 1:520 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4314
Practice Address - Country:US
Practice Address - Phone:541-930-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28409207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218702Medicaid
ORR142143Medicare PIN