Timothy Bock Icenogle, MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Ogden, UT. Individual provider (NPI-1).
NPI number1285683029
StatusActive
Last updated in NPPESDec 13, 2022
Details
- NPI
- 1285683029
- Entity type
- Individual (NPI-1)
- Name
- Timothy Bock Icenogle
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 9, 2006
- Certification date
- Dec 13, 2022
- Last updated
- Dec 13, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 126770044-1205 | UT | Yes |
| 204F00000X | Transplant Surgery | MD00026659 | WA | |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | S9004 | TX | |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | MD00026659 | WA |
Practice location
4403 Harrison Blvd Ste 3835Ogden, UT 84403-3331
Phone 801-387-3475 · Fax 801-387-3480
Mailing address
Po Box 27128Salt Lake City, UT 84127-0128
Other practice locations
100 Hillcrest Medical Blvd
Waco, TX 76712-8897
Waco, TX 76712-8897
Phone 254-202-2000 · Fax 254-202-5849
3415 W Horizon Ave
Spokane, WA 99208-8493
Spokane, WA 99208-8493
Phone 509-220-1900
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All 9 Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician providers in Ogden · All 4,116 providers in Ogden
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