Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mountain Pine Dermatology, PLLC

Organization Dermatology Physician · NPI 1659827665

Mountain Pine Dermatology, PLLC is a Dermatology Physician in Meridian, Idaho. Licensed in Idaho. Registered with an NPI since 2016.

Licensed in
ID
In the registry since
2016
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442
Phone: (208) 898-7467
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence O-0934 (ID)

Record details

NPI number1659827665
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Richard Thomas — Owner · (208) 250-7433
NPI enumeratedAugust 30, 2016
Last updated in NPPESJuly 5, 2020
Certification dateJuly 5, 2020
Mailing address4664 N Penngrove Way Ste 100, Meridian, ID 83646-7442

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