Provider Demographics
NPI:1518018969
Name:TOMLINSON, TIMOTHY GRIBBIN (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GRIBBIN
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BRACKEN ST N
Mailing Address - Street 2:P.O. BOX 602
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4513
Mailing Address - Country:US
Mailing Address - Phone:208-734-6089
Mailing Address - Fax:
Practice Address - Street 1:267 N CANYON DR
Practice Address - Street 2:NCMC SPECIALTY CLINIC
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-5500
Practice Address - Country:US
Practice Address - Phone:208-934-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP134213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002858600Medicaid
ID002858600Medicaid
1350706Medicare ID - Type Unspecified