Provider Demographics
NPI:1619124906
Name:NEUSCHWANDER, TIMOTHY BRUCE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRUCE
Last Name:NEUSCHWANDER
Suffix:
Gender:
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 STE 140
Mailing Address - Street 2:
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:906-228-9371
Practice Address - Street 1:8854 W EMERALD ST STE 140
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4845
Practice Address - Country:US
Practice Address - Phone:208-321-4790
Practice Address - Fax:208-321-4836
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14818207X00000X
IDM14818207XX0005X
MI4301102288207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine