Provider Demographics
NPI:1811094089
Name:MAYFIELD, TIMOTHY P (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 WESTOWN PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8207
Mailing Address - Country:US
Mailing Address - Phone:515-225-7001
Mailing Address - Fax:515-440-1953
Practice Address - Street 1:5901 WESTOWN PKWY STE 110
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8207
Practice Address - Country:US
Practice Address - Phone:515-225-7001
Practice Address - Fax:515-440-1953
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0434355208600000X
MOT2005016637208600000X
IA39766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1811094089Medicaid
IA1811094089Medicaid
IAIB1044002Medicare PIN