Organization
DERMATOLOGY OF EASTERN IDAHO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAY BISHOP M.D. (OWNER)
(208) 745-0200
Entity
Organization
Contact information
Practice address
703 RIGBY LAKE DR, RIGBY, ID 83442-5192
(208) 745-0200
(208) 745-0212
Mailing address
703 RIGBY LAKE DR, RIGBY, ID 83442-5192
(208) 745-0200
(208) 745-0212
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M-6569
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806512200
—
ID
Enumeration date
10/17/2005
Last updated
06/30/2010
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