Provider Demographics
NPI:1063906485
Name:ZONA, TIM RYAN
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:RYAN
Last Name:ZONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S 15TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2245
Mailing Address - Country:US
Mailing Address - Phone:712-454-0514
Mailing Address - Fax:
Practice Address - Street 1:121 S 15TH ST STE B
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2245
Practice Address - Country:US
Practice Address - Phone:712-454-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04774109Medicaid