Provider Demographics
NPI:1396132098
Name:ORTHMEYER, THOMAS JOHN JR (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:ORTHMEYER
Suffix:JR
Gender:M
Credentials:DO, MBA
Other - Prefix:DR
Other - First Name:T.J.
Other - Middle Name:
Other - Last Name:ORTHMEYER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DO, MBA
Mailing Address - Street 1:703 S AMERICANA BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4976
Mailing Address - Country:US
Mailing Address - Phone:208-706-6375
Mailing Address - Fax:
Practice Address - Street 1:703 S AMERICANA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4976
Practice Address - Country:US
Practice Address - Phone:208-706-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-11932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry