Individual
TIMOTHY J JOHANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6140 CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 327-5600
(208) 327-5602
Mailing address
6140 W CURTISIAN AVE STE 400, BOISE, ID 83704-8907
(208) 327-5600
(208) 327-5602
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M6183
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100000076910
REGENCE BLUESHIELD OF IDAHO
ID
05
—
1730101148
—
ID
01
—
194498
OMAP
OR
01
—
72371
BLUE CROSS OF IDAHO
ID
Enumeration date
07/24/2006
Last updated
06/13/2023
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