Provider Demographics
NPI:1740375021
Name:TIMMINS, BRYAN S (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:TIMMINS
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 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:3741 W 12600 S
Practice Address - Street 2:RIVERTON HOSPITAL
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-285-4000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89-181278-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870545614TI1OtherEDUCATORS MUTUAL
UT2090168OtherUNITED HEALTHCARE
UTPR01108OtherMOLINA
ID001574000Medicaid
UT107005668101OtherIHC
UT1502954OtherUMWA
UT53277OtherHEALTHY U
NV002086708Medicaid
WY108524700Medicaid
UT37827OtherPEHP
AZ840951Medicaid
UT52943OtherDESERET MUTUAL
UTQM0000075886OtherALTIUS
UT050046012Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT005532757Medicare ID - Type Unspecified
NV002086708Medicaid