| NPI | 1457912107 |
|---|---|
| Doing Business As | IDAHO SKIN INSTITUTE |
| Entity Type | Organization |
| Authorized Contact | EARL STODDARD Owner 208-238-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-06-27 |