Black, Timothy Roger

Black, Timothy Roger is an individual health care provider with primary practice located at 3652 Washington Pkwy , Idaho Falls ID 83404-7573. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Black, Timothy Roger can be contacted via phone (208) 528-8700.

Contact Information

Primary practice address
3652 Washington Pkwy Idaho Falls ID 83404-7573
Phone: (208) 528-8700
Fax: (208) 528-2802
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X P-169 Idaho

Profile Details

NPI number 1578753091
LBN Legal business name Black, Timothy Roger
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2007
Last updated Oct 31st, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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