TIMOTHY ROGER BLACK

IDAHO FALLS, ID
NPI1578753091
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy213E00000X Podiatrist
(Licence: ID  P-169)
Enumeration Date2007-07-31
Last Update Date2017-10-31
Business Address
Dr. TIMOTHY ROGER BLACK DPM
3652 WASHINGTON PKWY
IDAHO FALLS, ID 83404-7573
Phone number: 208-528-8700
Mailing Address
Dr. TIMOTHY ROGER BLACK DPM
1628 ELK CREEK DR
IDAHO FALLS, ID 83404-8349
Phone number: 208-528-8700
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