| NPI | 1528263670 |
|---|---|
| Former Legal Business Name | GERALD G. OVERLY, MD, PA |
| Entity Type | Organization |
| Authorized Contact | BROCK ARBEN ANDERSEN Principal Officer 208-452-5999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M-11462) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M3809) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2013-02-04 |