Individual
DR. TIMOTHY J. DYKSTRA
Active
Individual
DR. TIMOTHY J. DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O-216
ID
207R00000X
Internal Medicine Physician
OP00001634
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008949
—
WA
01
—
110184432
RR MEDICARE
ID
01
—
128877
LABOR & INDUSTRY
WA
01
—
1301846
DMERC
—
01
—
1376592758
REGENCE BLUE SHIELD
ID
05
—
1376592758
—
ID
01
—
S3028
BLUE CROSS OF IDAHO
ID
Enumeration date
05/10/2006
Last updated
03/08/2016
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