Icenogle, Timothy Bock

Icenogle, Timothy Bock is an individual health care provider with primary practice located at 4403 Harrison Blvd Ste 3835 , Ogden UT 84403-3331. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Transplant Surgery, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery). Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) is his primary health care specialty. Icenogle, Timothy Bock can be contacted via phone (801) 387-3475.

Contact Information

Primary practice address
4403 Harrison Blvd Ste 3835 Ogden UT 84403-3331
Phone: (801) 387-3475
Fax: (801) 387-3480
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Transplant Surgery 204F00000X MD00026659 Washington
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X S9004 Texas
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X MD00026659 Washington
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 126770044-1205 Utah

Profile Details

NPI number 1285683029
LBN Legal business name Icenogle, Timothy Bock
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 9th, 2006
Last updated Dec 13th, 2022 - about 3 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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Identifiers

StateTypeNumberIssuer
All States NPI 1285683029 NPPES
Washington MEDICAID 1072495
Washington MEDICAID 3756900
Washington MEDICAID 3505645

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