INTEGRATED DERMATOLOGY OF IDAHO LLC (NPI# 1508345091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508345091 |
| Entity Type | Organization |
| Organization Name | INTEGRATED DERMATOLOGY OF IDAHO LLC |
| Other Organization Name | GEM STATE DERMATOLOGY |
| Practice Address |
388 E Parkcenter Blvd Boise ID 83706-3942 |
| Mailing Address |
4700 Exchange Ct Ste 110 Boca Raton FL 33431-4450 |
| Practice Telephone | 2084249101 |
| Practice Fax Number | 2084245072 |
| Mailing Telephone | 5613142000 |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |
| Authorized Official Name | JEFFREY QUEEN (OWNER) |
| Authorized Official Telephone | 5613142000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| GEM State Dermatology | Doing Business As Name - Organization |
| Street Address |
388 E PARKCENTER BLVD |
| City | BOISE |
| State | ID |
| Zip Code | 83706-3942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| 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 |
|---|---|---|---|---|
| 1104220797 | Boise Skin Clinic Pllc | Dermatology | 1636 S Hadley Ave, Boise, ID 83709-2684 | 2014-10-10 |
| 1487899365 | Jaclyn Golus Mentzer | Dermatology | 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706 | 2008-12-08 |
| 1982736435 | Joseph P. Fetzek M.d., P.a. | Dermatology | 10222 Summerwind Dr, Boise, ID 83704-3950 | 2007-03-11 |
| 1154475556 | Joseph Patrick Fetzek | Dermatology | 6111 W Overland Rd, Boise, ID 83709-3018 | 2007-01-22 |
| 1225107386 | Jhon R Hall | Dermatology | 13176 W Persimmon Lane, Boise, ID 83713 | 2006-11-06 |
| 1124106364 | Lindie K Borton | Dermatology | 3811 N Garden Center Way, Boise, ID 83703-5007 | 2006-11-02 |
| 1992808893 | Jared M Scott | Dermatology | 1906 S Vista Ave, Boise, ID 83705-3453 | 2006-09-06 |
| 1104870567 | James H Stewart | Dermatology | 7733 W Emerald St, Boise, ID 83704 | 2006-05-20 |
| 1548214265 | Steven M Mings | Dermatology | 388 E. Parkcenter Blvd., Boise, ID 83706 | 2006-05-19 |
| 1134170855 | Marnie R Ririe | Dermatology | 1636 Hadley Ave., Boise, ID 83709 | 2006-05-15 |
| Find all providers in BOISE | ||||
Please comment or provide details below to improve the information on INTEGRATED DERMATOLOGY OF IDAHO LLC.
| 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.