Idaho Falls Dermatology P a
NPI #1487700464 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1487700464
- Entity Type
- Organization
- Organization Name
- Idaho Falls Dermatology P a
- Primary Specialty
- Specialist
- Enumeration Date
- Jan 25, 2007
- Last Updated
- Jul 5, 2016
Practice Location
- Address
- 2001 S WOODRUFF AVE
- Address 2
- STE 12A
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-6374
- Phone
- (208) 522-8945
Authorized Official
- Name
- CORNELIUS PAUL BROOKE
- Title
- M.D.
- Phone
- (208) 522-8945
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist |
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