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General NPI Number Information
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NPI Number | 1588802391
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Entity Type | Organization
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Legal Business Name | ALPINE DERMATOLOGY CLINIC P.C.
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 1049 SUMMERS DR
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City | REXBURG
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State | ID
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Zip | 83440-5335
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Country | US
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Telephone | 208-359-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 SUMMERS DR
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City | REXBURG
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State | ID
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Zip | 83440-5335
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Country | US
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Telephone | 208-359-4841
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DR. DANIEL R MARSHALL
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Credential | D.O.
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Telephone | 208-359-4841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | O-0508
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License Number State | ID
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