Organization
CLINIC 5C DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMERON CHESNUT MD (OWNER)
(509) 343-0250
Entity
Organization
Contact information
Practice address
1875 N LAKEWOOD DR FL 3, COEUR D ALENE, ID 83814-4928
(509) 343-0250
Mailing address
1875 N LAKEWOOD DR FL 3, COEUR D ALENE, ID 83814-4928
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Enumeration date
10/27/2025
Last updated
10/27/2025
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