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General NPI Number Information
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NPI Number | 1518018969
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Entity Type | Individual
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Provider Name | TIMOTHY GRIBBIN TOMLINSON DPM
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Gender | Male
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Dates
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Enumeration Date | 01/14/2007
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 267 N CANYON DR NCMC SPECIALTY CLINIC
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City | GOODING
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State | ID
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Zip | 83330-5500
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Country | US
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Telephone | 208-934-8829
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Fax |
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Provider Business Mailing Address
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Address Line | 355 BRACKEN ST N P.O. BOX 602
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City | TWIN FALLS
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State | ID
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Zip | 83301-4513
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Country | US
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Telephone | 208-734-6089
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P134
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License Number State | ID
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