NPI 1649478454

Idaho Dermatologic Surgery & Laser Center PA

Organisation MOHS-Micrographic Surgery Physician Boise, ID

Practice location

Address: 1488 N Knights Dr, Boise, ID 83712-6557
Phone: (208) 345-4050
Fax: (208) 327-9524
Mailing address: 967 E Parkcenter Blvd # 142, Boise, ID 83706-6721

Authorised official

Name: Teri J Cottingham
Title: Owner
Phone: (208) 869-2869

Registered specialties (4)

MOHS-Micrographic Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ND0101X Licence M-7506 (ID)

Other Dermatology providers in Idaho →

Dermatology Physician

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence M-7506 (ID)

Procedural Dermatology Physician

Allopathic & Osteopathic Physicians Taxonomy 207NS0135X Licence M-7506 (ID)

Medical Specialty Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QM2500X

Other Clinic/Center providers in Idaho →

Registry record

NPI: 1649478454
Entity type: Organization
NPI issued: 3 Jul 2007
Record last updated: 23 Feb 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.