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IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA NPI 1649478454


NPI Information

NPI: 1649478454
Provider Name: IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

Address:
1488 N KNIGHTS DR
BOISE, ID
ZIP 83712
Phone: (208) 345-4050
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IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA is a mohs-micrographic surgery dermatology in Boise, ID. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA NPI is 1649478454. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1488 N KNIGHTS DR
BOISE, ID
ZIP 83712-557
Phone: (208) 345-4050
Fax: (208) 327-9524

The provider's authorized official is Teri J Cottingham .
The authorized official title is Owner and has the following contact phone number (208) 869-2869.

The enumeration date for this NPI number is 7/3/2007 and was last updated on 2/23/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatologyM-7506IDAHONo
2207NS0135XDermatologyProcedural DermatologyM-7506IDAHONo
3261QM2500XClinic/CenterMedical SpecialtyNo
4207ND0101XDermatologyMOHS-Micrographic SurgeryM-7506IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11139318OTHERIDAHOPTAN
2805151100MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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