| NPI | 1912040270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MORGAN Practice Manager 208-424-9101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M7247) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: ID M7247) |
| 363A00000X Physician Assistant (Licence: ID PA377) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-12-02 |