Healthcare Provider Details

I. General information

NPI: 1316479231
Provider Name (Legal Business Name): JASON TIMMER CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 W JEFFERSON BLVD
FORT WAYNE IN
46804-6894
US

IV. Provider business mailing address

408 E WASHINGTON ST
BUTLER IN
46721-1179
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-8886
  • Fax: 260-432-1137
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: