Healthcare Provider Details

I. General information

NPI: 1609860477
Provider Name (Legal Business Name): TIMOTHY MARK HERR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 9TH ST SE
ROCHESTER MN
55904-6756
US

IV. Provider business mailing address

210 9TH ST SE
ROCHESTER MN
55904-6756
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-3443
  • Fax:
Mailing address:
  • Phone: 507-288-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM7263
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25217
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number65101
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: