Organization
HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES R WILLIS M.D. (PRESIDENT)
(208) 525-4888
Entity
Organization
Contact information
Practice address
2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
(208) 525-4888
(208) 525-4885
Mailing address
2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
(208) 525-4888
(208) 525-4885
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
M7012
ID
Other
Enumeration date
08/25/2006
Last updated
08/22/2020
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