Organization
GEM STATE DERMATOLOGY, PA
Active
Organization
GEM STATE DERMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE MORGAN (PRACTICE MANAGER)
(208) 424-9101
Entity
Organization
Contact information
Practice address
388 E. PARKCENTER BLVD., BOISE, ID 83706
(208) 424-9101
(208) 424-5072
Mailing address
PO BOX 1603, BOISE, ID 83702-1603
(208) 424-9101
(208) 424-5072
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M7247
ID
261QM2500X
Medical Specialty Clinic/Center
M7247
ID
363A00000X
Physician Assistant
PA377
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805054600
—
ID
Enumeration date
02/15/2007
Last updated
12/02/2014
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up