Organization
MOUNTAIN WEST DERM - BLACKHART PLLC
Active
Other names
Advanced Dermatology & Skin Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
BRET S BLACKHART MD (OWNER)
(775) 336-3624
Entity
Organization
Contact information
Practice address
1807 N HUTCHINSON RD, SPOKANE VALLEY, WA 99212-2444
(509) 456-7414
(509) 624-0763
Mailing address
1807 N HUTCHINSON RD, SPOKANE VALLEY, WA 99212-2444
(509) 456-7414
(509) 624-0763
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
01/08/2020
Last updated
01/08/2020
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