NPIMap

Organization Active NPI

High Valley Dermatology & Dermatologic Surgery, PC

  • MOHS-Micrographic Surgery Physician
  • Idaho Falls, ID
National Provider Identifier
1255449898
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
M7012 Issued in ID
Legal business name
HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
Practice address
2375 E Sunnyside Rd Ste J
Idaho Falls, ID 83404-8281
Phone
(208) 525-4888
Fax
(208) 525-4885
NPI assigned
Aug 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James R Willis, M.D.
Title
President
Phone
(208) 525-4888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X M7012 ID Primary

Addresses

Primary practice location

2375 E Sunnyside Rd Ste J
Idaho Falls, ID 83404-8281

Mailing address

2375 E Sunnyside Rd Ste J
Idaho Falls, ID 83404-8281
Phone (208) 525-4888

National Provider Directory

National Provider Directory

Locations

2085 Providence Way
Idaho Falls, ID 83404
Phone (208) 525-4888

2375 E Sunnyside Rd
Ste J
Idaho Falls, ID 83404
Phone (208) 522-7246

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255449898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 E SUNNYSIDE RD STE J",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048281",
            "telephone_number": "208-525-4888",
            "fax_number": "208-525-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 E SUNNYSIDE RD STE J",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048281",
            "telephone_number": "208-525-4888",
            "fax_number": "208-525-4885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-525-4888",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "ID",
            "license": "M7012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.