Healthcare Provider Details

I. General information

NPI: 1063906485
Provider Name (Legal Business Name): MR. TIM RYAN ZONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S 15TH ST STE B
CLARINDA IA
51632-2245
US

IV. Provider business mailing address

121 S 15TH ST STE B
CLARINDA IA
51632-2245
US

V. Phone/Fax

Practice location:
  • Phone: 712-454-0514
  • Fax:
Mailing address:
  • Phone: 712-454-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: