Provider Demographics
NPI:1891703070
Name:TOMLINSON, CYNDA L (MD)
Entity type:Individual
Prefix:DR
First Name:CYNDA
Middle Name:L
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5285
Mailing Address - Country:US
Mailing Address - Phone:208-542-9111
Mailing Address - Fax:541-322-3501
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8929
Practice Address - Country:US
Practice Address - Phone:208-788-4122
Practice Address - Fax:208-788-6430
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227238Medicaid
OR131299Medicare ID - Type Unspecified
OR227238Medicaid