OrganizationActive
Mountain Pine Dermatology, PLLC
NPI 1659827665 · Dermatology Physician · Meridian, ID
Provider details
- NPI number
- 1659827665
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Richard Thomas, Owner(208) 250-7433
- License
- O-0934 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442
Phone: (208) 898-7467
Approximate (ZIP-level) locationGet directions
Mailing address
4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442
Registry dates
- Enumerated
- 2016-08-30
- Last updated
- 2020-07-05
- Certified
- 2020-07-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.