Organization
CT DERM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL R THORNFELDT MD (OWNER)
(208) 452-7450
Entity
Organization
Contact information
Practice address
811 NW 12TH ST, FRUITLAND, ID 83619-2268
(208) 452-7450
Mailing address
811 NW 12TH ST, FRUITLAND, ID 83619-2268
(208) 452-7450
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
06/01/2006
Last updated
03/27/2015
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