Provider Demographics
NPI:1154374254
Name:TINSMAN, PETER W (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:TINSMAN
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 1:18401 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:IA
Mailing Address - Zip Code:52039-9453
Mailing Address - Country:US
Mailing Address - Phone:563-556-2639
Mailing Address - Fax:
Practice Address - Street 1:18401 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:IA
Practice Address - Zip Code:52039-9453
Practice Address - Country:US
Practice Address - Phone:563-556-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38679Medicare UPIN
IAI1713Medicare ID - Type Unspecified
F38679Medicare UPIN