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NPI Code Detail

MEDICARE: DR. MARK RAYMOND TIMS PSY.D.

MEDICARE: DR. MARK RAYMOND TIMS PSY.D.
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
1103TC0700XClinical Psychologist63010008189MI
2103TC0700XClinical Psychologist008189MI

General Provider Information

NPI Number : 1255324877
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK RAYMOND TIMS PSY.D.
Provider Business Mailing Address
First Line : 601 HIGHWAY 6 WEST
Second Line :
City : IOWA CITY
State : IA
Zip : 52246
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2501 CAPEHART RD
Second Line :
City : OFFUTT AFB
State : NE
Zip : 68113-1043
Country : US
Telephone Number : 402-294-1110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 05/27/2021

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