Basic Information
| Provider Information | |||||||||
| NPI: | 1780752469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUHONEN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 E 17TH N | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836471757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058016577 | ||||||||
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| Practice Location | |||||||||
| Address1: | 465 MCKENNA DR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085879703 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NM2007-0097 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 40961 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD186714 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD00043473 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | M-11354 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.