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General NPI Number Information
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NPI Number | 1043206113
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Entity Type | Individual
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Provider Name | TIMOTHY C. DYKSTRA MD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 307 E SCENIC VALLEY AVE
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City | INDIANOLA
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State | IA
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Zip | 50125-4865
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Country | US
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Telephone | 515-961-8448
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Fax | 515-643-9100
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Provider Business Mailing Address
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Address Line | PO BOX 1475
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City | DES MOINES
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State | IA
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Zip | 50305-1475
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Country | US
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Telephone | 515-961-8448
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Fax | 515-643-9100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 31362
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31362
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-31362
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License Number State | IA
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