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EAGLE DERMATOLOGY, PLLC
NPI 1417456385
Dermatology in Eagle, ID

Active since February 06, 2018CLIA 13D2143283 · Certificate of Compliance
323 E RIVERSIDE DR STE 234, EAGLE, ID 83616(208) 391-7210(208) 391-2130 Get Directions Write a Review

NPPES record last updated: February 6, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Eagle Dermatology, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAGLE DERMATOLOGY, PLLC (NPI 1417456385) is a healthcare organization registered as a dermatology in Eagle, Idaho and active in the NPI registry since February 2018. The organization holds a CLIA Certificate of Compliance certificate valid through March 11, 2027 and lists Jennifer Annette Guerrero, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1417456385
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameEAGLE DERMATOLOGY, PLLC
Location Address323 E RIVERSIDE DR STE 234Eagle, ID 83616-6865
Mailing Address372 S Eagle Rd # 126Eagle, ID 83616-5908 · (208) 391-7210 · Fax (208) 391-2130
Phone(208) 391-7210
Fax(208) 391-2130
Organization SubpartNo
Authorized OfficialJennifer Annette GuerreroPractice Manager · (208) 391-7210
Enumeration DateFebruary 6, 2018
✔ NPI 1417456385 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in ID · O-1094
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X · License O-1094 (ID)
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X · License O-1094 (ID)
Also ListedDermatology · Clinical & Laboratory Dermatological ImmunologyTaxonomy 207NI0002X · License O-1094 (ID)
Also ListedDermatology · Pediatric DermatologyTaxonomy 207NP0225X · License O-1094 (ID)
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X · License O-1094 (ID)
323 E RIVERSIDE DR STE 234, Eagle, ID 83616
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 13D2143283

Eagle Dermatology, LLC · Eagle, ID
Active · expires Mar 11, 2027
CLIA Number13D2143283
Laboratory TypePhysician Office
Certificate Effective DateMarch 12, 2025
Certificate Expiration DateMarch 11, 2027
Laboratory DirectorGabriel G. Guerrero
Laboratory Phone(208) 391-7210
Laboratory LocationEagle Dermatology, LLC74 N Fisher Parkway, Eagle, ID 83616
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OPTIMAL HEALTHCARE PLLC
Family Medicine
323 E RIVERSIDE DR STE 234
EAGLE, ID 83616
Ada County (208) 514-3362

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eagle Dermatology, PLLC's NPI number?

The NPI number for Eagle Dermatology, PLLC is 1417456385. It was assigned to this organization in the NPPES registry on February 6, 2018.

Where is Eagle Dermatology, PLLC located?

Eagle Dermatology, PLLC is located at 323 E Riverside Dr Ste 234, Eagle, ID 83616. The listed phone number is (208) 391-7210.

What is Eagle Dermatology, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Eagle Dermatology, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 13D2143283) is associated with this NPI, valid through March 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Eagle Dermatology, PLLC accept?

Health plans from Moda Health Plan, Inc. list Eagle Dermatology, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Eagle Dermatology, PLLC was last updated on February 6, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.