Provider Demographics
NPI:1487613931
Name:TIMBOE, DOUGLAS M (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:TIMBOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 MILLS CIVIC PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8345
Mailing Address - Country:US
Mailing Address - Phone:515-224-9666
Mailing Address - Fax:515-224-5913
Practice Address - Street 1:6010 MILLS CIVIC PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8345
Practice Address - Country:US
Practice Address - Phone:515-224-9666
Practice Address - Fax:515-224-5913
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA31368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4127175Medicaid
IA1487613931Medicaid
IA719260347Medicare PIN
IA4127175Medicaid
IAI14412Medicare PIN
IA1487613931Medicaid