Provider Demographics
NPI:1851493951
Name:TIMINS, BRUCE IRA (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:IRA
Last Name:TIMINS
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 1:900 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4000
Mailing Address - Country:US
Mailing Address - Phone:575-543-7283
Mailing Address - Fax:575-543-6918
Practice Address - Street 1:900 W ASH ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4000
Practice Address - Country:US
Practice Address - Phone:575-543-7283
Practice Address - Fax:575-543-6918
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36915207RC0000X
NMMD2010-0552207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3148Medicare ID - Type Unspecified
FL066515100Medicaid
FL262397800Medicaid
95639AOtherBLUE CROSS
D63550Medicare UPIN
FL95639Medicare ID - Type UnspecifiedINDIVIDUAL
030119OtherAVMED
019273OtherHEALTH OPTIONS