Idaho Dermatologic Surgery & Laser Center PA

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

M-7506 Issued in ID

Legal business name

IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA

Practice address

1488 N Knights Dr
Boise, ID 83712-6557

Phone

(208) 345-4050

Fax

(208) 327-9524

NPI assigned

Jul 3, 2007

Last updated

Feb 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Teri J Cottingham, M.D.

Title

Owner

Phone

(208) 869-2869

Specialties & licenses 4

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1649478454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 E PARKCENTER BLVD # 142",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066721",
            "telephone_number": "208-345-4050",
            "fax_number": "208-327-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1488 N KNIGHTS DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126557",
            "telephone_number": "208-345-4050",
            "fax_number": "208-327-9524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DERMATOLOGIC SURGERY & LASER CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "COTTINGHAM",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-869-2869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M-7506",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "ID",
            "license": "M-7506",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "ID",
            "license": "M-7506",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "1139318",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805151100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idaho Dept of Health & Welfare Amh PSR Boise
• Idaho Dept of Health & Welfare CMH Clinic Boise
• Idaho Dept of Health & Welfare Esc Region 4
• Idaho Dept of Health & Welfare Itp Region 4
• Idaho Dept of Health & Welfare Region 4 CMH PSR Boise
• Idaho Dermatology Mohs Collective PLLC
• Idaho Diabetes and Endocrine Associates, PA (Idaho Diabetes & Endocrine Associates, PA)
• Idaho Division of Behavioral Health
• Idaho Dysphagia Specialists LLC (Northwest Mobile FEES)
• Idaho Eating and Body Institute

• MOHS-Micrographic Surgery Physician in Boise, ID
• Providers in Boise, ID by specialty
• MOHS-Micrographic Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.