Organization
COMPREHENSIVE DERMATOLOGY OF IDAHO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN SCOTT OWSLEY M.D. (OWNER)
(208) 467-7546
Entity
Organization
Contact information
Practice address
16111 N BRINSON ST STE 100, NAMPA, ID 83687-5509
(208) 467-7546
(208) 467-7500
Mailing address
16111 N BRINSON ST STE 100, NAMPA, ID 83687-5509
(208) 467-7546
(208) 467-7500
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M8483
ID
363A00000X
Physician Assistant
PA280
ID
Other
Enumeration date
11/05/2011
Last updated
12/23/2019
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