OrganizationActive
Idaho Dermatologic Surgery & Laser Center PA
NPI 1649478454 · MOHS-Micrographic Surgery Physician · Boise, ID
Provider details
- NPI number
- 1649478454
- Entity type
- Organization
- Primary specialty
- MOHS-Micrographic Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Teri Cottingham, Owner(208) 869-2869
- License
- M-7506 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Medical Specialty Clinic/Center261QM2500X
Ambulatory Health Care Facilities
Practice location
1488 N Knights Dr
Boise, ID 83712-6557
Phone: (208) 345-4050
Fax: (208) 327-9524
Approximate (ZIP-level) locationGet directions
Mailing address
967 E Parkcenter Blvd # 142
Boise, ID 83706-6721
Registry dates
- Enumerated
- 2007-07-03
- Last updated
- 2024-02-23
- Certified
- 2024-02-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.