Provider Demographics
NPI:1114691813
Name:STODDARD & BINGHAM MEDICAL OF TWIN FALLS PLLC
Entity Type:Organization
Organization Name:STODDARD & BINGHAM MEDICAL OF TWIN FALLS PLLC
Other - Org Name:IDAHO SKIN INSTITUTE OF TWIN FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-238-7546
Mailing Address - Street 1:147 W CHUBBUCK RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2314
Mailing Address - Country:US
Mailing Address - Phone:208-238-7546
Mailing Address - Fax:208-237-9643
Practice Address - Street 1:1411 FALLS AVE E STE 1002
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3459
Practice Address - Country:US
Practice Address - Phone:208-595-5424
Practice Address - Fax:208-595-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548482482OtherPERSONAL NPI
ID1528533296OtherPERSONAL NPI
ID1760400238OtherPERSONAL NPI
1164834073OtherPERSONAL NPI