Basic Information
Provider Information
NPI: 1245388743
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWINTON
FirstName: TIMOTHY
MiddleName: WAYNE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2353 SE 14TH ST
Address2:  
City: DES MOINES
State: IA
PostalCode: 503201109
CountryCode: US
TelephoneNumber: 5152481400
FaxNumber: 5152481440
Practice Location
Address1: 412 E CHURCH ST
Address2:  
City: MARSHALLTOWN
State: IA
PostalCode: 501582947
CountryCode: US
TelephoneNumber: 6417534021
FaxNumber: 6417534025
Other Information
ProviderEnumerationDate: 01/08/2007
LastUpdateDate: 12/05/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X28378IAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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