# ALPINE DERMATOLOGY CLINIC P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588802391
- **Authorized official:** DR. DANIEL R MARSHALL D.O. (OWNER, CEO)
- **Authorized official phone:** (208) 359-4841

## Contact information

- **Practice address:** 1049 SUMMERS DR, REXBURG, ID 83440-5335
- **Practice address phone:** (208) 359-4841
- **Mailing address:** 1049 SUMMERS DR, REXBURG, ID 83440-5335
- **Mailing address phone:** (208) 359-4841

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | O-0508 | ID | Yes |

## Other

- **Enumeration date:** 02/02/2009
- **Last updated:** 04/05/2019