OrganizationActive
Snake River Dermatology, PA
NPI 1528263670 · Dermatology Physician · Fruitland, ID
Provider details
- NPI number
- 1528263670
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Brock Andersen, Principal Officer(208) 452-5999
- License
- M3809 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1611 N Whitley Dr
#7
Fruitland, ID 83619
Phone: (208) 452-5999
Fax: (208) 452-4499
Street-level locationGet directions
Mailing address
1611 N Whitley Dr
Fruitland, ID 83619
Other names (DBA / former)
- Former legal business name
- Gerald G. Overly, MD, PA
Registry dates
- Enumerated
- 2007-06-19
- Last updated
- 2013-02-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.