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General NPI Number Information
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NPI Number | 1104111376
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Entity Type | Individual
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Provider Name | TIMOTHY JOSEPH BAURES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 125 E IDAHO ST STE 100
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City | BOISE
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State | ID
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Zip | 83712-6202
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Country | US
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Telephone | 208-381-1950
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Fax | 208-381-1951
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 4301500677
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 65528
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 65528
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 8271845
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License Number State | ID
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