Provider Demographics
NPI:1902869803
Name:BLANKERS, TIMOTHY DEAN (DPM)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DEAN
Last Name:BLANKERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:STE C
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4342
Mailing Address - Country:US
Mailing Address - Phone:712-262-7511
Mailing Address - Fax:712-262-3658
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:STE C
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:712-262-7511
Practice Address - Fax:712-262-3658
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00757213ES0103X
MN646213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN426843100Medicaid
IA0269555Medicaid
MN480035127Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN0288350004Medicare NSC
MN0288350002Medicare NSC
MN426843100Medicaid
MN480000439Medicare PIN
IA0269555Medicaid
IA0288350004Medicare NSC
IA0288350001Medicare NSC
IAU90645Medicare UPIN
MN0288350001Medicare NSC
IAI7491Medicare PIN
IA480035127Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IA0288350006Medicare NSC
IA0288350002Medicare NSC