Organization
BOISE LASER AND COSMETIC SURGERY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRET J RODGERS M.D. (PHYSICIAN)
(208) 939-9000
Entity
Organization
Contact information
Practice address
6077 N EAGLE RD, BOISE, ID 83713-0997
(208) 939-9000
(208) 939-9580
Mailing address
6077 N EAGLE RD, BOISE, ID 83713-0997
(208) 939-9000
(208) 939-9580
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806174700
—
ID
Enumeration date
02/23/2009
Last updated
11/08/2010
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