Individual
TIMOTHY WAYNE CORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPRP, BS
Contact information
Practice address
2201 IRONWOOD PL, COEUR D ALENE, ID 83814-2670
(208) 769-4222
(208) 771-0628
Mailing address
2201 IRONWOOD PL, COEUR D ALENE, ID 83814-2670
(208) 769-4222
(208) 771-0628
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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