Healthcare Provider Details

I. General information

NPI: 1871561720
Provider Name (Legal Business Name): ALAN L. TIMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 CONNECTICUT AVENUE S HP CENTRAL MN CLINICS
SARTELL MN
56377-2486
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-5220
  • Fax: 320-203-2113
Mailing address:
  • Phone: 952-883-5375
  • Fax: 320-203-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number26883
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: