Healthcare Provider Details

I. General information

NPI: 1043206113
Provider Name (Legal Business Name): TIMOTHY C. DYKSTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
CENTERVILLE IA
52544-9017
US

IV. Provider business mailing address

PO BOX 677075
DALLAS TX
75267-7075
US

V. Phone/Fax

Practice location:
  • Phone: 641-437-4111
  • Fax:
Mailing address:
  • Phone: 641-437-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number31362
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-31362
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31362
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-31362
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: