Timothy Bock Icenogle
Transplant Surgeon Cardiothoracic Vascular Surgeon
3415 W Horizon Ave
Spokane
, Washington 99208-8493
Timothy Bock Icenogle
Transplant Surgeon Cardiothoracic Vascular Surgeon
3415 W Horizon Ave
Spokane
, Washington 99208-8493
(509) 220-1900
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About
Features
Specialties
- Transplant Surgeon
- Cardiothoracic Vascular Surgeon
Languages spoken
- English
Location
First Address
- Timothy Bock Icenogle
- 3415 W Horizon Ave
- Spokane, WA
- Zip : 99208-8493
- Phone : (509) 220-1900
Second Address
- Timothy Bock Icenogle
- 3415 W Horizon Ave
- Spokane, WA
- Zip : 99208-8493
- Phone : (509) 220-1900
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Is Timothy Bock Icenogle a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 204F00000X | Transplant Surgeon | MD00026659 | WA |
| Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD00026659 | WA |
| N | 208G00000X | Cardiothoracic Vascular Surgeon | S9004 | TX |
National Provider Identifier
| NPI | 1285683029 |
|---|---|
| Provider Name | Timothy Bock Icenogle |
| First Address | Spokane, WA 99208-8493 |
| Second Address | Spokane, WA 99208-8493 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/05/2006 |
| Last Update Date | 10/05/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1072495 | (05) | WA |
| 3505645 | (05) | MT |
| 3756900 | (05) | ID |
| C99677 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.