Provider Demographics
NPI:1871561720
Name:TIMS, ALAN L (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:TIMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:320-203-2113
Practice Address - Street 1:2251 CONNECTICUT AVENUE S
Practice Address - Street 2:HP CENTRAL MN CLINICS
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2486
Practice Address - Country:US
Practice Address - Phone:320-253-5220
Practice Address - Fax:320-203-2113
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN26883208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1423031OtherMEDICA
MN361208200Medicaid
MN40022TIOtherBCBSM
MN40022TIOtherBCBSM
MN029000336Medicare ID - Type Unspecified