Organization
MOUNTAIN PINE DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD SCOTT THOMAS D.O. (OWNER)
(208) 250-7433
Entity
Organization
Contact information
Practice address
4664 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7442
(208) 898-7467
Mailing address
4664 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7442
(208) 898-7467
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
O-0934
ID
Other
Enumeration date
08/30/2016
Last updated
07/05/2020
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