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General NPI Number Information
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NPI Number | 1760477368
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Entity Type | Individual
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Provider Name | TIMOTHY JOSEPH FLOCK MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 320 WARNER DR
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City | LEWISTON
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State | ID
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Zip | 83501
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Country | US
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Telephone | 208-743-3523
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Fax | 208-746-8741
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Provider Business Mailing Address
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Address Line | 320 WARNER DR
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City | LEWISTON
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State | ID
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Zip | 83501
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Country | US
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Telephone | 208-743-3523
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Fax | 208-746-8741
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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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | MD00032793
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | M6831
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License Number State | ID
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