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Timothy Bock Icenogle, MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Ogden, Utah
NPI 1285683029

Timothy Bock Icenogle is a Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician based in Salt Lake City, UT. Timothy Bock Icenogle practices in Ogden, UT and has the professional credentials of MD. The NPI Number for Timothy Bock Icenogle is 1285683029 and holds a License No. MD00026659 (Utah).

The current practice location address for Timothy Bock Icenogle is 4403 Harrison Blvd Ste 3835, Ogden, UT and can be reached out via phone at 801-387-3475 and via fax at 801-387-3480. You can also correspond with Timothy Bock Icenogle through the mailing address at PO BOX 27128, SALT LAKE CITY, UT - 84127-0128 (mailing address contact number: ).

Location: 4403 Harrison Blvd Ste 3835, Ogden, UT, 84127-0128
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1285683029
Provider Name
Timothy Bock Icenogle
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
4403 Harrison Blvd Ste 3835, Ogden, UT, 84127-0128
Phone Number
801-387-3475
Fax Number
801-387-3480
Provider Enumeration Date
05/09/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1072495 05 WA
3756900 05 ID
3505645 05 MT
institution
Provider Business Practice Location Address Details
Address
4403 Harrison Blvd Ste 3835
City
Ogden
State
Utah
Zip
84403-3331
Phone Number
801-387-3475
Fax Number
801-387-3480
person
Provider Business Mailing Address Details
Address
4403 Harrison Blvd Ste 3835
City
Ogden
State
Utah
Zip
84403-3331
Phone Number
801-387-3475
Fax Number
801-387-3480
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Transplant Surgery
Speciality
-
Taxonomy
204F00000X
License No.
S9004 (Texas)
Definition
Definition to come.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Thoracic Surgery (Cardiothoracic Vascular Surgery)
Speciality
-
Taxonomy
208G00000X
License No.
MD00026659 (Washington)
Definition
A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.
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