Provider Demographics
NPI:1992731459
Name:TIMMER, JEREMY RILEY (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:RILEY
Last Name:TIMMER
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 1:201 4TH ST STE 5B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-769-3501
Mailing Address - Fax:318-769-3502
Practice Address - Street 1:201 4TH ST STE 5B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-769-3501
Practice Address - Fax:318-769-3502
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200015207P00000X, 208600000X
LAMD.2000152086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K053Medicare ID - Type Unspecified
LAI49427Medicare UPIN