Healthcare Provider Details

I. General information

NPI: 1972890911
Provider Name (Legal Business Name): NATHAN J TIMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E NORWAY AVE
MITCHELL SD
57301-4790
US

IV. Provider business mailing address

402 E NORWAY AVE
MITCHELL SD
57301-4790
US

V. Phone/Fax

Practice location:
  • Phone: 605-990-5005
  • Fax: 605-990-5006
Mailing address:
  • Phone: 605-990-5005
  • Fax: 605-990-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9264
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: