Provider Demographics
NPI:1922085992
Name:WINTERS, TIMOTHY R (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:WINTERS
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 1:1100 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1710
Mailing Address - Country:US
Mailing Address - Phone:319-377-4844
Mailing Address - Fax:319-377-0852
Practice Address - Street 1:1100 35TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1710
Practice Address - Country:US
Practice Address - Phone:319-377-4844
Practice Address - Fax:319-377-0852
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080116813OtherRR MEDICARE
IA1922085992Medicaid
IA5111575Medicaid
IA4111575Medicaid
IA7111575Medicaid
IA4111575Medicaid
IA7111575Medicaid