IDAHO FALLS DERMATOLOGY P A NPI 1487700464

NPI Information

IDAHO FALLS DERMATOLOGY P A is a specialist in Idaho Falls, ID. The provider is 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. IDAHO FALLS DERMATOLOGY P A NPI is 1487700464. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2001 S WOODRUFF AVE
STE 12A
IDAHO FALLS, ID
ZIP 83404-374
Phone: (208) 522-8945

The provider's authorized official is Cornelius Paul Brooke .
The authorized official title is M.d. and has the following contact phone number (208) 522-8945.

The CLIA number assigned to this NPI record is 13D1063459 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/25/2007 and was last updated on 7/5/2016.

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:

Other Identifiers

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

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