Individual
DR. TIMOTHY A. DEFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3231 S NATIONAL AVE, SPRINGFIELD, MO 65807-7304
(417) 885-0803
(417) 841-0110
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2001013325
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145785001
—
AR
05
—
205332109
—
MO
Enumeration date
11/01/2006
Last updated
05/03/2013
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