Healthcare Provider Details

I. General information

NPI: 1598873523
Provider Name (Legal Business Name): TIMOTHY D MOMANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 39TH AVE POB 207
AMANA IA
52203-8229
US

IV. Provider business mailing address

603 38TH AVE
AMANA IA
52203-8018
US

V. Phone/Fax

Practice location:
  • Phone: 319-622-3231
  • Fax: 319-622-3077
Mailing address:
  • Phone: 319-622-6292
  • Fax: 319-622-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26119
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: