Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 2001014083 | MO |
NPI | 1013931815 |
---|---|
Provider Name | Dr. Dennis M Timko |
First Address | Eureka, MO 63025-1106 |
Second Address | Eureka, MO 63025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 29/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
308423607 | (05) | MO |
U95266 | (02) | MO |