NPI age
18 years
Enumerated 2007-06-19
● Active Type 2 · Organization
Snake River Dermatology, PA
Snake River Dermatology, PA is 1 of 102 dermatology organizations in Idaho.
Primary specialty
Dermatology
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Andersen
Principal Officer
Last NPPES update
2013-02-04
Source: monthly bulk 2026-05
How this organization compares
Across 102 active dermatology providers in Idaho.
NPI age
18 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-06Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
1611 N Whitley Dr, #7
Fruitland, ID 83619
Mailing address
1611 N Whitley Dr, Suite #7
Fruitland, ID 83619
Authorized official
Brock Arben Andersen, MD
Principal Officer
📞 2084525999
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Cody Brown Counselor NPI 1851766976
- Lana Usilton, C.N. Nutritionist NPI 1811255755
Specialties
-
Dermatology PrimaryA dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Gerald G. Overly, MD, PA
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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