Individual
DR. TIMOTHY ROGER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3652 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 528-8700
(208) 528-2802
Mailing address
1628 ELK CREEK DR, IDAHO FALLS, ID 83404-8349
(208) 528-8700
(208) 528-2802
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P-169
ID
Other
Enumeration date
07/31/2007
Last updated
10/31/2017
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