NPI 1578753091

Timothy Roger Black, DPM

Practitioner Podiatrist Idaho Falls, ID

Practice location

Address: 3652 Washington Pkwy, Idaho Falls, ID 83404-7573
Phone: (208) 528-8700
Fax: (208) 528-2802
Mailing address: 1628 Elk Creek Dr, Idaho Falls, ID 83404-8349

Registered specialties

Podiatrist Primary

Podiatric Medicine & Surgery Service Providers Taxonomy 213E00000X Licence P-169 (ID)

Other Podiatrist providers in Idaho →

Registry record

NPI: 1578753091
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Jul 2007
Record last updated: 31 Oct 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.