Organization
PHYSICIAN SKIN CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CANDACE MARIE BUNNAGE (BILLING MANAGER)
(208) 542-9111
Entity
Organization
Contact information
Practice address
730 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2082807848
ID
Other
Enumeration date
02/15/2007
Last updated
08/22/2020
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