IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA (NPI# 1649478454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649478454 |
| Entity Type | Organization |
| Organization Name | IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA |
| Practice Address |
999 N Curtis Rd Ste 505 Boise ID 83706-1336 |
| Practice Telephone | 2083279521 |
| Practice Fax Number | 2083279524 |
| Mailing Telephone | 2083279521 |
| Mailing Fax Number | 2083279524 |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2013-02-07 |
| Authorized Official Name | DR. TERI J COTTINGHAM (OWNER) |
| Authorized Official Telephone | 2083279521 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | M-7506 | ID | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
M-7506 | ID | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
M-7506 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 805151100 | 05 | |
| ID | PTAN | 1139318 | 01 |
| Street Address |
999 N CURTIS RD STE 505 |
| City | BOISE |
| State | ID |
| Zip Code | 83706-1336 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982691598 | Richard W Wilson | Psychiatry & Neurology | 999 N Curtis Rd, Ste 506, Boise, ID 83706-1336 | 2005-09-29 |
| 1477814952 | Eric F Holt | Psychiatry & Neurology | 999 N Curtis Rd, # 502, Boise, ID 83706-1336 | 2012-05-31 |
| 1700164092 | Rhoda E Heaton | Physician Assistant | 999 N Curtis Rd, Suite 415, Boise, ID 83706-1334 | 2011-08-03 |
| 1639403041 | Stefanie Jean Magee | Physician Assistant | 999 N Curtis Rd, Suite 415, Boise, ID 83706-1334 | 2009-10-01 |
| 1851625925 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 999 N Curtis Rd, Suite 102, Boise, ID 83706-1336 | 2009-09-23 |
| 1013168830 | Brian John Hall | Pathology | 999 N Curtis Rd, Ste 117, Boise, ID 83706-1336 | 2008-10-10 |
| 1174789994 | Tracey Reeve | Physician Assistant | 999 N Curtis Rd, Suite 415, Boise, ID 83706-1334 | 2008-07-31 |
| 1821261918 | Mark Owen Moore | Pathology | 999 N Curtis Rd, Suite 117, Boise, ID 83706-1336 | 2008-04-09 |
| 1275718595 | Britani Rhea Hill | Surgery | 999 N Curtis Rd, Suite 415, Boise, ID 83706-1334 | 2008-01-05 |
| 1124226378 | D Peter Reedy Md Pa | Neurological Surgery | 999 N Curtis Rd, 307, Boise, ID 83706-1336 | 2007-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295908127 | Idaho Skin Surgery Center, PC | Dermatology | 1906 S Vista Ave, Boise, ID 83705-3453 | 2008-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528279189 | Brandon Lynn Miner | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2007-05-25 |
| 1417456385 | Eagle Dermatology, Pllc | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616-6865 | 2018-02-06 |
| 1568880995 | Ryan Bruce Thorpe | Dermatology | 1618 S Millenium Way Ste 100, Meridian, ID 83642-6457 | 2014-04-02 |
| 1063840288 | High Valley Dermatology and Surgery | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2013-10-25 |
| 1891025334 | High Valley Dermatology & Dermatologic Surgery LLC | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2010-01-06 |
| 1245484096 | Kurtis B Reed | Dermatology | 714 N College Rd, Suite A, Twin Falls, ID 83301-5812 | 2008-11-06 |
| 1255449898 | High Valley Dermatology & Dermatologic Surgery, PC | Dermatology | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2006-08-25 |
| 1760400238 | Earl Stoddard | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-07-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.