| NPI | 1649478454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI J COTTINGHAM Owner 208-869-2869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID M-7506) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M-7506) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: ID M-7506) | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2024-02-23 |