DR. Timothy Roger Black, DPM

NPI #1578753091 in Idaho Falls, Idaho

Provider Information

NPI Number: 1578753091
Entity Type: Individual
Name: DR. Timothy Roger Black, DPM
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Podiatrist
Credential: DPM
Enumeration Date: Jul 31, 2007
Last Updated: Oct 31, 2017

Practice Location

Address: 3652 WASHINGTON PKWY
City: Idaho Falls
State: Idaho
ZIP Code: 83404-7573
Phone: (208) 528-8700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Podiatrist	213E00000X	Primary

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