Individual
MR. EARL CEPHAS CHESTER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 S 15TH AVE, POCATELLO, ID 83201
(208) 232-2106
(208) 232-0432
Mailing address
115 S 15TH AVE, POCATELLO, ID 83201
(208) 232-2106
(208) 232-0432
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M3346
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1110276
MEDICARE PROVIDER
ID
Enumeration date
01/08/2007
Last updated
04/17/2008
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