Individual
TIMOTHY MANGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1301 33RD ST S, SAINT CLOUD, MN 56301-9668
(320) 251-8181
Mailing address
2557 N DODGE ST, IOWA CITY, IA 52245-9556
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002420
IA
Other
Enumeration date
12/09/2006
Last updated
06/17/2021
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