Individual
DR. TIMOTHY J STODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1450 AVIATION DR, SUITE 202, HAILEY, ID 83333-8785
(208) 727-8970
(208) 727-8979
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
M-8916
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821212788
—
ID
Enumeration date
04/12/2007
Last updated
10/29/2013
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