| NPI | 1295908127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED SCOTT President 208-433-1114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M-10116) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID M-10116) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: ID M-10116) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2014-12-12 |