Provider Demographics
NPI:1083663868
Name:DOERR, TIMOTHY EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:DOERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8854 W EMERALD ST
Mailing Address - Street 2:STE 140
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4845
Mailing Address - Country:US
Mailing Address - Phone:208-321-4790
Mailing Address - Fax:208-321-4836
Practice Address - Street 1:8854 W EMERALD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4844
Practice Address - Country:US
Practice Address - Phone:208-321-4790
Practice Address - Fax:208-321-4836
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7259207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00171922OtherTRAVELERS MEDICARE
ID000010004063OtherREGENCE BLUE SHIELD
ID804191700Medicaid
ID72595OtherBLUE CROSS
IDP00171922OtherTRAVELERS MEDICARE
IDG28224Medicare UPIN