CT DERM PC (NPI# 1902843485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902843485 |
| Entity Type | Organization |
| Organization Name | CT DERM PC |
| Practice Address |
811 Nw 12th St Fruitland ID 83619-2268 |
| Practice Telephone | 2084527450 |
| Mailing Telephone | 2084527450 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2015-03-27 |
| Authorized Official Name | CARL R THORNFELDT (OWNER) |
| Authorized Official Telephone | 2084527450 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Street Address |
811 NW 12TH ST |
| City | FRUITLAND |
| State | ID |
| Zip Code | 83619-2268 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205466281 | Jeanna Rae Rendo | Nurse Practitioner | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2020-01-18 |
| 1386103760 | Brittney Irons | Nurse Practitioner | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2019-03-15 |
| 1093228769 | Amanda Lynn Turner | Physician Assistant | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2017-11-15 |
| 1770876625 | Melissa Anne Pace | Nurse Practitioner | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2011-05-25 |
| 1083653489 | Carl R Thornfeldt | Dermatology | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992322382 | Dallin Scott Wilkes | Physical Therapist | 2175 N Whitley Dr., Fruitland, ID 83619 | 2020-07-01 |
| 1659925113 | Treasure Valley Classical Academy | Local Education Agency (LEA) | 500 Sw 3rd Street, Fruitland, ID 83619 | 2019-08-01 |
| 1083146559 | Total Renal Care, Inc. | Clinic/Center | 815 Nw 13th St, Fruitland, ID 83619 | 2017-04-03 |
| 1154563948 | Becky Jean Wolery | Social Worker | 910 Nw 16th St Ste 101, Fruitland, ID 83619 | 2009-03-25 |
| 1740426196 | John Wesley Linhart | Physical Therapist | 1116 Nw 16th Street, Fruitland, ID 83619 | 2009-01-06 |
| 1528263670 | Snake River Dermatology, Pa | Dermatology | 1611 N Whitley Dr, #7, Fruitland, ID 83619 | 2007-06-19 |
| 1568591204 | John Linton Close | Registered Nurse | 1509 N Whitley Drive, Suite 5, Fruitland, ID 83619 | 2007-03-05 |
| 1629110671 | Payette School Dist #373 | Local Education Agency (LEA) | 303 Sw 3rd Street, Fruitland, ID 83619 | 2007-02-13 |
| 1912075839 | William Frederick Martsch | Dentist | 315 N. Whitley, Fruitland, ID 83619 | 2006-11-30 |
| 1992880132 | Ryan David Hillam | Dentist | 1820 N.whitley Drive, Fruitland, ID 83619 | 2006-10-26 |
| Find all providers in zip 83619 | ||||
| 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 |
|---|---|---|---|---|
| 1528263670 | Snake River Dermatology, Pa | Dermatology | 1611 N Whitley Dr, #7, Fruitland, ID 83619 | 2007-06-19 |
| 1558349852 | Brock Arben Andersen | Dermatology | 2101 N Whitley Dr, Fruitland, ID 83619-2132 | 2006-01-06 |
| 1083653489 | Carl R Thornfeldt | Dermatology | 811 Nw 12th St, Fruitland, ID 83619-2268 | 2006-06-04 |
| 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 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.