TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER, PLLC (NPI# 1598271645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598271645 |
| Entity Type | Organization |
| Organization Name | TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER, PLLC |
| Practice Address |
6051 N Eagle Rd Boise ID 83713-0997 |
| Mailing Address |
12965 W Paint Dr Boise ID 83713-1947 |
| Practice Telephone | 2083518088 |
| Mailing Telephone | 2083518088 |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | DUSTIN R PORTELA (PRESIDENT) |
| Authorized Official Telephone | 2083518088 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | O-1052 | ID | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 999 N Curtis Rd Ste 307, Boise, ID 837061333 | 2085194333 | 2082059134 |
| Street Address |
6051 N EAGLE RD |
| City | BOISE |
| State | ID |
| Zip Code | 83713-0997 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063462075 | Gary J Millward | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2006-05-11 |
| 1154870251 | Jacob Shane Tebbs | Physician Assistant | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2016-09-29 |
| 1588002547 | Dustin Ray Portela | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2013-06-11 |
| 1952628745 | Ryan J Harris | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2010-05-03 |
| 1407047202 | Mariya Rose Ostermiller | Physician Assistant | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2007-08-06 |
| 1104975168 | Clinton Clark Dpm LLC | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2007-01-09 |
| 1982711578 | Boise Podiatry Clinic, P. A. | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713 | 2006-08-23 |
| 1578514618 | Scott A Graviet | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2006-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| 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 |
|---|---|---|---|---|
| 1508345091 | Integrated Dermatology of Idaho LLC | Dermatology | 388 E Parkcenter Blvd, Boise, ID 83706-3942 | 2018-08-07 |
| 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 |
| Find all providers in BOISE | ||||
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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.