MEDICARE: TIM THURMAN MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	M7428	ID

General Provider Information

NPI Number	:	1184020075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM THURMAN MD PC

Provider Business Mailing Address
First Line	:	933 S UTAH
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402
Country	:	US
Telephone Number	:	208-552-1759
Fax Number	:	208-552-1870

Provider Business Practice Location Address
First Line	:	933 S UTAH AVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-3322
Country	:	US
Telephone Number	:	208-552-1759
Fax Number	:	208-552-1870

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ROBERT THURMAN
Credential	:	MD
Telephone Number	:	208-552-1759

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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