Provider Demographics
NPI:1528059086
Name:VERMILLION, TIMOTHY J (DO)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:VERMILLION
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1205 COPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7002
Mailing Address - Country:US
Mailing Address - Phone:515-266-1199
Mailing Address - Fax:515-266-0615
Practice Address - Street 1:1205 COPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7002
Practice Address - Country:US
Practice Address - Phone:515-266-1199
Practice Address - Fax:515-266-0615
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA01866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1528059086Medicaid
IA1528059086Medicaid
IAI9749Medicare ID - Type Unspecified
IAA01687Medicare UPIN