Organization
MOUNTAIN WEST DERM-BLACKHART, PLLC
Active
Parent organization
MOUNTAIN WEST DERM-BLACKHART, PLLC
Other names
Dermatology Clinic of Idaho
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOUNTAIN WEST DERM-BLACKHART, PLLC
Authorized official
BRET S BLACKHART MD (OWNER)
(775) 336-3624
Entity
Organization
Contact information
Practice address
7733 W EMERALD ST, BOISE, ID 83704-9020
(208) 939-4599
(208) 939-5010
Mailing address
201 FRANKLIN RD FL 3, BRENTWOOD, TN 37027-5214
(615) 309-2636
(615) 309-2536
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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