Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1200301 | KS |
Y | 222Z00000X | Podiatrist | 1200301 | KS |
NPI | 1033229448 |
---|---|
Provider Name | Dr. Trent J Timson |
First Address | Mcpherson, KS 67460-2301 |
Second Address | Mcpherson, KS 67460-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100317700A | (05) | KS |
5067668 | AETNA (01) | KS |
U70793 | (02) | KS |