Dermatology of Eastern Idaho PA

NPI #1548259161 in Rigby, Idaho

Provider Information

NPI Number: 1548259161
Entity Type: Organization
Organization Name: Dermatology of Eastern Idaho PA
Primary Specialty: Specialist
Enumeration Date: Oct 17, 2005
Last Updated: Jun 30, 2010

Practice Location

Address: 703 RIGBY LAKE DR
City: Rigby
State: Idaho
ZIP Code: 83442-5192
Phone: (208) 745-0200

Authorized Official

Name: KAY BISHOP, M.D.
Title: OWNER
Phone: (208) 745-0200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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