Provider Demographics
NPI:1750880829
Name:ALAN LEE TIMS MD LLC
Entity type:Organization
Organization Name:ALAN LEE TIMS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-250-3571
Mailing Address - Street 1:2007 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1249
Mailing Address - Country:US
Mailing Address - Phone:320-250-3571
Mailing Address - Fax:
Practice Address - Street 1:2007 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1249
Practice Address - Country:US
Practice Address - Phone:320-250-3571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty