Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Timothy Roger Black, DPM

Individual provider Podiatrist · NPI 1578753091

Dr. Timothy Roger Black, DPM is a Podiatry in Idaho Falls, Idaho. Graduated from California School of Podiatric Medicine in 2000, 26 years ago. Accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
26
Trained at
California School of Podiatric Medicine
Licensed in
ID
In the registry since
2007
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

3652 Washington Pkwy
Idaho Falls, ID 83404-7573
Phone: (208) 528-8700
Fax: (208) 528-2802
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Podiatrist (primary) Taxonomy 213E00000X · Licence P-169 (ID)

Record details

NPI number1578753091
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorNo
NPI enumeratedJuly 31, 2007
Last updated in NPPESOctober 31, 2017
Mailing address1628 Elk Creek Dr, Idaho Falls, ID 83404-8349

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPODIATRY
Medical schoolCALIFORNIA SCHOOL OF PODIATRIC MEDICINE
Graduated 2000 (26 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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