EARL STODDARD (NPI# 1760400238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760400238 |
| Entity Type | Individual |
| Full Name | EARL STODDARD |
| Credential | M.D. |
| Practice Address |
147 W Chubbuck Rd Chubbuck ID 83202-2314 |
| Practice Telephone | 2082387546 |
| Practice Fax Number | 2082379643 |
| Mailing Telephone | 2082387546 |
| Mailing Fax Number | 2082379643 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-08-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
M9280 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807206400 | 05 | |
| ID | RAILRAOD MEDICARE PTAN | P00239843 | 01 |
| Street Address |
147 W CHUBBUCK RD |
| City | CHUBBUCK |
| State | ID |
| Zip Code | 83202-2314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760451454 | Leslie Irene Burnside | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-03-15 |
| 1558756106 | Trevor Batty | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2015-03-31 |
| 1972745594 | Stoddard Medical, Inc | Dermatology | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2009-03-27 |
| 1720195530 | Ryan T Mcculloch | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-08-25 |
| 1992716674 | Amy Louise Mckinlay | Physician Assistant | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2006-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700379682 | Vera Whole Health, Wa PC | Clinic/Center | 219 Phil Meador Ave, Pocatello, ID 83202 | 2018-06-14 |
| 1649712597 | Angie M Mccurdy | Audiologist | 4155 Yellowstone Hwy, Pine Ridge Mall, Pocatello, ID 83202 | 2016-11-09 |
| 1285180836 | Beverly Grigg Jones | Counselor | 210 W. Burnside, Chubbuck, ID 83202 | 2016-09-01 |
| 1376992503 | Andrea Walsh | Nurse Practitioner | 1133 Call Creek Dr, Ste A, Pocatello, ID 83202 | 2016-06-08 |
| 1215381181 | Specialized Physical Therapy Pllc | Clinic/Center | 4141 Poleline Rd Ste A, Pocatello, ID 83202 | 2016-04-18 |
| 1457713588 | Jennifer Ann Gould | Radiologic Technologist | 907 Ryan Street, Chubbuck, ID 83202 | 2016-03-28 |
| 1154714897 | Phoenix Management LLC | Day Training, Developmentally Disabled Services | 10991 Deerridge Dr., Chubbuck, ID 83202 | 2015-03-05 |
| 1750781449 | Jennifer Lynn Seaich | Counselor | 4460 Center Way, Center Counseling, Pocatello, ID 83202 | 2014-08-29 |
| 1336562412 | Kurt Layton | Counselor | 337 Joel, Chubbuck, ID 83202 | 2014-01-27 |
| 1245653468 | Hannah's Place LLC | Occupational Therapist | 240 W Burnside Ave Ste D, Chubbuck, ID 83202 | 2014-01-23 |
| Find all providers in zip 83202 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528279189 | Brandon Lynn Miner | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2007-05-25 |
| 1417456385 | Eagle Dermatology, Pllc | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616-6865 | 2018-02-06 |
| 1568880995 | Ryan Bruce Thorpe | Dermatology | 1618 S Millenium Way Ste 100, Meridian, ID 83642-6457 | 2014-04-02 |
| 1063840288 | High Valley Dermatology and Surgery | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2013-10-25 |
| 1891025334 | High Valley Dermatology & Dermatologic Surgery LLC | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2010-01-06 |
| 1245484096 | Kurtis B Reed | Dermatology | 714 N College Rd, Suite A, Twin Falls, ID 83301-5812 | 2008-11-06 |
| 1295908127 | Idaho Skin Surgery Center, PC | Dermatology | 1906 S Vista Ave, Boise, ID 83705-3453 | 2008-04-11 |
| 1255449898 | High Valley Dermatology & Dermatologic Surgery, PC | Dermatology | 2375 E Sunnyside Rd Ste J, Idaho Falls, ID 83404-8281 | 2006-08-25 |
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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.