NPI age
19 years
Enumerated 2006-12-12
Across 102 active dermatology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 863436 | DMBA |
| 01 (ID) | 10147364 | BLUE SHIELS |
| 01 (ID) | S4927 | BLUE CROSS |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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