Provider Demographics
NPI:1124120050
Name:TIMMONS, BRET ANDREW (DO)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:ANDREW
Last Name:TIMMONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-1362
Mailing Address - Country:US
Mailing Address - Phone:208-226-3200
Mailing Address - Fax:208-226-3218
Practice Address - Street 1:510 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1362
Practice Address - Country:US
Practice Address - Phone:208-226-3200
Practice Address - Fax:208-226-3218
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806849400Medicaid
IDO-331OtherOSTEOPATHIC LICENSURE
IDO-331OtherOSTEOPATHIC LICENSURE