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Dermatology Of Eastern Idaho Pa
Specialist in Rigby, Idaho
NPI 1548259161

Dermatology Of Eastern Idaho Pa is a Specialist based in Rigby, ID. Dermatology Of Eastern Idaho Pa practices in Rigby, ID. The NPI Number for Dermatology Of Eastern Idaho Pa is 1548259161 and holds a License No. M-6569 (Idaho).

The current practice location address for Dermatology Of Eastern Idaho Pa is 703 Rigby Lake Dr, Rigby, ID and can be reached out via phone at 208-745-0200 and via fax at 208-745-0212.

Location: 703 Rigby Lake Dr, Rigby, ID, 83442-5192
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1548259161
Provider Name
Dermatology Of Eastern Idaho Pa
Credential
Provider Entity Type
Organization
Address
703 Rigby Lake Dr, Rigby, ID, 83442-5192
Phone Number
208-745-0200
Fax Number
208-745-0212
Provider Enumeration Date
10/17/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
806512200 05 ID
institution
Provider Business Practice Location Address Details
Address
703 Rigby Lake Dr
City
Rigby
State
Idaho
Zip
83442-5192
Phone Number
208-745-0200
Fax Number
208-745-0212
person
Provider Business Mailing Address Details
Address
703 Rigby Lake Dr
City
Rigby
State
Idaho
Zip
83442-5192
Phone Number
208-745-0200
Fax Number
208-745-0212
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
M-6569 (Idaho)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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