Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | M10198 | ID |
N | 207ND0101X | MOHS-Micrographic Surgeon | M10198 | ID |
N | 207NS0135X | Procedural Dermatology | M10198 | ID |
NPI | 1346432226 |
---|---|
Provider Name | Dr. Lindsay D. Sewell |
First Address | Idaho Falls, ID 83404-4945 |
Second Address | Idaho Falls, ID 83404-4945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 27/03/2009 |