Individual
DR. TIMOTHY MORRIS DEBLIECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 367-6123
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-7182
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114961042
—
ID
Enumeration date
06/14/2006
Last updated
12/15/2023
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