Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M6831 | ID |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD00032793 | WA |
NPI | 1760477368 |
---|---|
Provider Name | Dr. Timothy Joseph Flock |
First Address | Lewiston, ID 83501 |
Second Address | Lewiston, ID 83501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 24/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00001000102 | REGENCE (01) | ID |
003688100 | (05) | ID |
8177388 | (05) | WA |
DA673 | BLUE CROSS OF IDAHO (01) | ID |
G12429 | (02) | ID |