Organization
MARK E HINKSON DERMATOLOGY PA
Active
Other names
Mountain West Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ELDON HINKSON D.O (PRESIDENT)
(208) 528-6653
Entity
Organization
Contact information
Practice address
3425 MERLIN DR STE 200, IDAHO FALLS, ID 83404-7430
(208) 528-6653
(208) 528-6676
Mailing address
3425 MERLIN DR STE 200, IDAHO FALLS, ID 83404-7430
(208) 528-6653
(208) 528-6676
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
O-323
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10147364
BLUE SHIELS
ID
01
—
863436
DMBA
ID
01
—
S4927
BLUE CROSS
ID
Enumeration date
12/12/2006
Last updated
08/22/2020
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