Organization
BMH, INC.
Active
Organization
BMH, INC.
Active
Other names
Dr. Adam Wray's Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RUDOLPH (PSO SUPPORT SPECIALIST)
(208) 782-3992
Entity
Organization
Contact information
Practice address
1151 HOSPITAL WAY STE D, POCATELLO, ID 83201-5091
(208) 233-1451
Mailing address
1151 HOSPITAL WAY STE D, POCATELLO, ID 83201-5091
(208) 233-1451
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N220
BLUE CROSS GRP
ID
Enumeration date
07/31/2007
Last updated
04/17/2008
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