Individual
DR. TIMOTHY J. DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Mailing address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
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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