EAGLE DERMATOLOGY, PLLC (NPI# 1417456385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1417456385 |
Entity Type | Organization |
Organization Name | EAGLE DERMATOLOGY, PLLC |
Practice Address |
323 E Riverside Dr Ste 234 Eagle ID 83616-6865 |
Mailing Address |
372 S Eagle Rd # 126 Eagle ID 83616-5908 |
Practice Telephone | 2083917210 |
Practice Fax Number | 2083912130 |
Mailing Telephone | 2083917210 |
Mailing Fax Number | 2083912130 |
Enumeration Date | 2018-02-06 |
Last Update Date | 2018-02-06 |
Authorized Official Name | MRS. JENNIFER ANNETTE GUERRERO (PRACTICE MANAGER) |
Authorized Official Telephone | 2083917210 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
O-1094 | ID | Allopathic & Osteopathic Physicians |
N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
O-1094 | ID | Allopathic & Osteopathic Physicians |
N | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
O-1094 | ID | Allopathic & Osteopathic Physicians |
N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
O-1094 | ID | Allopathic & Osteopathic Physicians |
N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
O-1094 | ID | Allopathic & Osteopathic Physicians |
Y | 207N00000X | Dermatology | O-1094 | ID | Allopathic & Osteopathic Physicians |
Street Address |
323 E RIVERSIDE DR STE 234 |
City | EAGLE |
State | ID |
Zip Code | 83616-6865 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
1659629244 | Lily Caywood | Speech-Language Pathologist | 935 E. Winding Creek Dr. Ste. 120, Eagle, ID 83616 | 2012-08-29 |
Find all providers in zip 83616 |
Taxonomy Code | 207N00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
1942402169 | Wade Robert Keller | Dermatology | 1605 E Riverside Dr, Eagle, ID 83616-6237 | 2007-06-01 |
1699866822 | Gregory Lynn Flint | Dermatology | 868 E Riverside Dr, Suite 200, Eagle, ID 83616-6019 | 2006-09-26 |
1215553409 | Colorado Mountain Medical, LLC | Dermatology | 377 Sylvan Lake Road, Suite 210, Eagle, CO 81631 | 2020-06-23 |
1649543323 | Keller Skin & Cancer Care PC | Dermatology | 1605 E Riverside Drive, Eagle, ID 83616 | 2012-02-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356942437 | Stoddard & Bingham Medical of Rexburg Pllc | Dermatology | 859 S Yellowstone Hwy Ste 3302, Rexburg, ID 83440-6200 | 2020-11-04 |
1508345091 | Integrated Dermatology of Idaho LLC | Dermatology | 388 E Parkcenter Blvd, Boise, ID 83706-3942 | 2018-08-07 |
1306209556 | Garrett Coman | Dermatology | St. Luke's Dermatology, 191 5th Street West, Ketchum, ID 83340 | 2016-04-04 |
1104220797 | Boise Skin Clinic Pllc | Dermatology | 1636 S Hadley Ave, Boise, ID 83709-2684 | 2014-10-10 |
1164834073 | Colby Bingham | Dermatology | 1344 Hiland Ave Ste D, Burley, ID 83318-1564 | 2014-05-27 |
1699194530 | Dustin Larsen | Dermatology | 2199 N Merrit Crk Loop, Coeur D Alene, ID 83814-4949 | 2014-04-08 |
1265795660 | Richard Scott Thomas | Dermatology | 4664 N Penngrove Way Ste 100, Meridian, ID 83646-7442 | 2012-06-20 |
1316216369 | Ashley Anne Hamstra | Dermatology | 421 E Lakeside Ave Ste 105, Coeur D Alene, ID 83814-2848 | 2011-12-20 |
1487899365 | Jaclyn Golus Mentzer | Dermatology | 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706 | 2008-12-08 |
1013170125 | Benjamin Carl Ringger | Dermatology | 2288 N Merritt Creek Loop, Coeur D Alene, ID 83814-4959 | 2008-07-08 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.