Eagle Dermatology, PLLC
NPI 1417456385ActiveOrganization· Dermatology· Eagle, ID
Dermatology in Eagle, Idaho, registered in NPPES in February 2018. The authorized official on file is Jennifer Annette Guerrero, Practice Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1417456385 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 6, 2018 |
| Last updated in NPPES | Feb 6, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | O-1094 | ID |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | O-1094 | ID |
| Dermatology, Dermatopathology | 207ND0900X | O-1094 | ID |
| Dermatology, Clinical & Laboratory Dermatological Immunology | 207NI0002X | O-1094 | ID |
| Dermatology, Pediatric Dermatology | 207NP0225X | O-1094 | ID |
| Dermatology, Procedural Dermatology | 207NS0135X | O-1094 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (ID) |
|---|
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