Healthcare Provider Details

I. General information

NPI: 1386644227
Provider Name (Legal Business Name): TIMOTHY GERARD LEEDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S 19TH ST STE 100
NEVADA IA
50201-2902
US

IV. Provider business mailing address

640 S 19TH ST STE 100
NEVADA IA
50201-2902
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-5413
  • Fax: 515-382-7107
Mailing address:
  • Phone: 515-382-5413
  • Fax: 515-382-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD-27989
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-27989
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: