Provider Demographics
NPI:1740726975
Name:TIMOTHY FLOYD, MD, PLLC
Entity type:Organization
Organization Name:TIMOTHY FLOYD, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-938-0434
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-1240
Mailing Address - Country:US
Mailing Address - Phone:208-367-7463
Mailing Address - Fax:208-367-7507
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-367-7463
Practice Address - Fax:208-367-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5623207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty