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Individual

JOHN W CARLISLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 298-4521
Mailing address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 298-4521

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD00012692
WA
207N00000X
Dermatology Physician
Primary
MD8169
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
145739
WA LABOR & INDUSTRIES
WA
05
8147845
WA
Enumeration date
10/23/2006
Last updated
07/09/2007
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