Provider Demographics
NPI:1750093571
Name:IDAHO DERMATOLOGY MOHS COLLECTIVE PLLC
Entity type:Organization
Organization Name:IDAHO DERMATOLOGY MOHS COLLECTIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-600-1330
Mailing Address - Street 1:3668 N HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6914
Mailing Address - Country:US
Mailing Address - Phone:208-600-1330
Mailing Address - Fax:
Practice Address - Street 1:3668 N HARBOR LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6914
Practice Address - Country:US
Practice Address - Phone:208-600-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-23
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty