Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2020010314 | MO |
Y | 2080P0204X | Pediatric Emergency Doctor | 2020010314 | MO |
NPI | 1316467335 |
---|---|
Provider Name | Dr. Theresa Mary Timm |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 03/01/2022 |