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Contact Information

TIMOTHY R BLACK, DPM
3652 WASHINGTON PKWY
IDAHO FALLS, ID83404-7573
 Phone: 208-528-8700
 Fax: 208-528-2802
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for TIMOTHY R BLACK · (Male)

NPI # 1578753091
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 07/31/2007
Last updated 10/31/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • ID License # P-169
Hospital affiliation(s)
  • MOUNTAIN VIEW HOSPITAL - (Acute Care)
    2325 CORONADO STREET
    IDAHO FALLS, ID 83404
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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