Provider Demographics
NPI:1730101148
Name:JOHANS, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:JOHANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6140 W CURTISIAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-327-5600
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:6140 CURTISIAN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8880
Practice Address - Country:US
Practice Address - Phone:208-327-5600
Practice Address - Fax:208-327-5602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6183207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR194498OtherOMAP
ID72371OtherBLUE CROSS OF IDAHO
ID1730101148Medicaid
ID100000076910OtherREGENCE BLUESHIELD OF IDAHO
WA49491OtherWA DEPARTMENT OF LABOR
348737300OtherUS DEPARTMENT OF LABOR
OR194498OtherOMAP
ID72371OtherBLUE CROSS OF IDAHO
ID000010162965OtherREGENCE BLUE SHIELD TALUS
ID137903Medicare PIN
ID8K248OtherBC OF IDAHO GROUP
ID000010004934OtherREGENCE BLUE SHIELD