CT Derm PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CT DERM PC

Practice address

811 NW 12TH St
Fruitland, ID 83619-2268

Phone

(208) 452-7450

NPI assigned

Jun 1, 2006

Last updated

Mar 27, 2015By 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

Carl R Thornfeldt, MDNPI 1083653489

Title

Owner

Phone

(208) 452-7450

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Carl R Thornfeldt, MD

  • Dermatology Physician
  • Fruitland, ID
  • NPI 1083653489
  Authorized official Same address or phone

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1902843485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 NW 12TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192268",
            "telephone_number": "208-452-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 NW 12TH ST",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192268",
            "telephone_number": "208-452-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CT DERM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "THORNFELDT",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-452-7450",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Counseling Services
• City of Fruitland (Payette County Paramedics)
• John Linton Close, RN
• Jesse Ray Cobb, LCSW
• Irene A Connell, OTR
• Bonnie Curren, HIS
• Current Physical Therapy LLC
• Cassie Dahle
• Jan Olof Dahlin, M.D.
• Ciera Daley, PA-C

• Dermatology Physician in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; 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.