Organization
SNAKE RIVER DERMATOLOGY, PA
Active
Organization
SNAKE RIVER DERMATOLOGY, PA
Active
Other names
Gerald G. Overly, MD, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BROCK ARBEN ANDERSEN II MD (PRINCIPAL OFFICER)
(208) 452-5999
Entity
Organization
Contact information
Practice address
1611 N WHITLEY DR, #7, FRUITLAND, ID 83619
(208) 452-5999
(208) 452-4499
Mailing address
1611 N WHITLEY DR, SUITE #7, FRUITLAND, ID 83619
(208) 452-5999
(208) 452-4499
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M-11462
ID
207N00000X
Dermatology Physician
M3809
ID
Other
Enumeration date
06/19/2007
Last updated
02/04/2013
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