Organization
STODDARD MEDICAL, INC
Active
Organization
STODDARD MEDICAL, INC
Active
Other names
Idaho Skin Institute, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
EARL R STODDARD M.D. (OWNER/PHYSICIAN)
(208) 238-7546
Entity
Organization
Contact information
Practice address
147 W CHUBBUCK RD, CHUBBUCK, ID 83202-2314
(208) 238-7546
(208) 237-9643
Mailing address
147 W CHUBBUCK RD, CHUBBUCK, ID 83202-2314
(208) 238-7546
(208) 237-9643
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M9280
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11311121
MEDICARE PTAN
ID
Enumeration date
03/27/2009
Last updated
04/04/2012
Update your record
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