Provider Demographics
NPI:1033108071
Name:FLEMING, TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2232
Mailing Address - Country:US
Mailing Address - Phone:307-754-4559
Mailing Address - Fax:307-754-7733
Practice Address - Street 1:1511 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-4122
Practice Address - Country:US
Practice Address - Phone:307-347-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2071A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY06006340OtherRAILROAD MEDICARE
WY115857100Medicaid
WY308637OtherBLUE CROSS BLUE SHEILD
MT0032810Medicaid
WYD20571Medicare UPIN
MT0032810Medicaid