Organization
EARL C CHESTER JR. MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL C CHESTER II MD (OWNER)
(208) 232-2107
Entity
Organization
Contact information
Practice address
115 S 15TH AVE, SUITE E, POCATELLO, ID 83201-4068
(208) 232-2107
Mailing address
115 S 15TH AVE, SUITE E, POCATELLO, ID 83201-4068
(208) 232-2107
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M3346
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1110276
MEDICARE PROVIDER
ID
Enumeration date
03/14/2008
Last updated
03/18/2008
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