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NPI Code Detail

MEDICARE: MR. TIMOTHY VAN LAYMAN

MEDICARE: MR. TIMOTHY VAN LAYMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1253J00000XFoster Care Agency

General Provider Information

NPI Number : 1083906234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY VAN LAYMAN
Provider Business Mailing Address
First Line : 1733 N 350 W
Second Line :
City : SUNSET
State : UT
Zip : 84015-2713
Country : US
Telephone Number : 801-866-6460
Fax Number :
Provider Business Practice Location Address
First Line : 3742 W 4000 S
Second Line :
City : WEST HAVEN
State : UT
Zip : 84401-9630
Country : US
Telephone Number : 435-723-1799
Fax Number : 435-723-2521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2011
Last Update Date : 09/19/2011

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