Provider Demographics
NPI:1992738587
Name:BREON, TIMOTHY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:BREON
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 1:1229 C AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4246
Mailing Address - Country:US
Mailing Address - Phone:641-672-3360
Mailing Address - Fax:641-672-9262
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4246
Practice Address - Country:US
Practice Address - Phone:641-672-3360
Practice Address - Fax:641-672-9262
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34607208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0102OtherJOHN DEERE
IA020053265OtherRAILROAD MEDICARE
IA236354OtherMIDLANDS CHOICE
IA0262410Medicaid
IA49943OtherBLUE CROSS BLUE SHIELD
IAIA0102OtherJOHN DEERE
IAH63384Medicare UPIN