Organization
BOISE SKIN CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARNIE R RIRIE MD (MANAGER)
(208) 258-2078
Entity
Organization
Contact information
Practice address
1636 S HADLEY AVE, BOISE, ID 83709-2684
(208) 209-7898
(208) 258-2079
Mailing address
1636 S HADLEY AVE, BOISE, ID 83709-2684
(208) 209-7898
(208) 258-2079
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M-9342
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134170855
—
ID
Enumeration date
10/10/2014
Last updated
01/22/2019
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