NPIMap

Organization Active NPI

Stoddard Medical, Inc

Doing business as Idaho Skin Institute, Inc.

  • Dermatology Physician
  • Chubbuck, ID
National Provider Identifier
1972745594
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M9280 Issued in ID
Legal business name
STODDARD MEDICAL, INC
Doing business as
Idaho Skin Institute, Inc.
Practice address
147 W Chubbuck Rd
Chubbuck, ID 83202-2314
Phone
(208) 238-7546
Fax
(208) 237-9643
NPI assigned
Mar 27, 2009
Last updated
Apr 4, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

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

Authorized official

Name
Earl R Stoddard, M.D.NPI 1760400238
Title
Owner/Physician
Phone
(208) 238-7546

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M9280 ID Primary

Addresses

Primary practice location

147 W Chubbuck Rd
Chubbuck, ID 83202-2314

Mailing address

147 W Chubbuck Rd
Chubbuck, ID 83202-2314
Phone (208) 238-7546

Other identifiers 1

IdentifierTypeStateIssuer
11311121OtherIDMEDICARE PTAN

Other names 1

  • Idaho Skin Institute, Inc. Doing business as

National Provider Directory

National Provider Directory

Locations

147 W Chubbuck Rd
Chubbuck, ID 83202
Phone (208) 238-7546

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1972745594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 W CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022314",
            "telephone_number": "208-238-7546",
            "fax_number": "208-237-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 W CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022314",
            "telephone_number": "208-238-7546",
            "fax_number": "208-237-9643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STODDARD MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-27",
        "last_updated": "2012-04-04",
        "status": "A",
        "authorized_official_last_name": "STODDARD",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "208-238-7546",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M9280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "11311121",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Skin Institute, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chubbuck, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; 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.