Basic Information
| Provider Information | |||||||||
| NPI: | 1811345838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEMAIRE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 966 | ||||||||
| Address2: | |||||||||
| City: | NOME | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669071068 | ||||||||
| FaxNumber: | 4259179141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 GREG KRUSCHEK AVE | ||||||||
| Address2: | |||||||||
| City: | NOME | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075629229 | ||||||||
| FaxNumber: | 9075614806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2016 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 110432 | AK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 140167 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1646661 | 05 | AK | MEDICAID |