Organization
TIMOTHY A VAN DYNE DPM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ALLEN VAN DYNE DPM (PRESIDENT)
(559) 435-0261
Entity
Organization
Contact information
Practice address
5777 N FRESNO ST, SUITE 102, FRESNO, CA 93710-6065
(559) 435-0261
Mailing address
5777 N FRESNO ST, SUITE 102, FRESNO, CA 93710-6065
(559) 435-0261
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
E2025
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E2025
MEDICARE ID 000E20250
CA
Enumeration date
04/19/2007
Last updated
02/24/2012
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