| NPI | 1548758501 |
|---|---|
| Doing Business As | DERMATOLOGY CLINIC OF IDAHO |
| Entity Type | Organization |
| Authorized Contact | BRET S BLACKHART Owner 775-336-3624 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-04-25 |