# MARK LEO TIMMERMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1972525574
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | NH 7663 | NH | Yes |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0103422YPNH01 | BC/BS INDIVIDUAL NUMBER | NH |
| 01 | — | 140824540 | BC/BS MASS BILLING \# | MA |
| 01 | — | 30D0084963 | CLIA NUMBER | NH |
| 01 | — | 50Y095600NH01 | BC/BS NH GROUP NUMBER | NH |
| 01 | — | B86207 | HPHC BILLING NUMBER | NH |
| 01 | — | NH 7663 | NH STATE LICENSE | NH |