Organization
IDAHO SKIN SURGERY CENTER, PC
Active
Organization
IDAHO SKIN SURGERY CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED SCOTT MD (PRESIDENT)
(208) 433-1114
Entity
Organization
Contact information
Practice address
1906 S VISTA AVE, BOISE, ID 83705-3453
(208) 433-1114
(208) 433-1115
Mailing address
1906 S VISTA AVE, BOISE, ID 83705-3453
(208) 433-1114
(208) 433-1115
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M-10116
ID
207ND0101X
MOHS-Micrographic Surgery Physician
M-10116
ID
207NS0135X
Procedural Dermatology Physician
M-10116
ID
Other
Enumeration date
04/11/2008
Last updated
12/12/2014
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