Organization
IDAHO SKIN INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EARL STODDARD MD (OWNER)
(208) 238-7546
Entity
Organization
Contact information
Practice address
147 W CHUBBUCK RD, CHUBBUCK, ID 83202-2314
(208) 238-7546
(208) 237-9643
Mailing address
147 W CHUBBUCK RD, CHUBBUCK, ID 83202-2314
(208) 238-7546
(208) 237-9643
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/13/2022
Last updated
02/04/2025
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