Basic Information
| Provider Information | |||||||||
| NPI: | 1841386240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIMOCK | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TIMOCK | ||||||||
| OtherFirstName: | JOSH | ||||||||
| OtherMiddleName: | MCCARTHY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1401 25TH ST S | ||||||||
| Address2: | BMG ADMIN | ||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594055161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067318888 | ||||||||
| FaxNumber: | 4067318876 | ||||||||
| Practice Location | |||||||||
| Address1: | 26 DOS PALAS ROAD | ||||||||
| Address2: | |||||||||
| City: | ARROYO SECO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706463583 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2006024386 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD2015-0674 | NM | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 68060 | MT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.