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

Snake River Dermatology, PA

Organization Dermatology Physician · NPI 1528263670

Snake River Dermatology, PA is a Dermatology Physician in Fruitland, Idaho. Licensed in Idaho. Registered with an NPI since 2007.

Licensed in
ID
In the registry since
2007
Specialties on file
2
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1611 N Whitley Dr #7
Fruitland, ID 83619
Phone: (208) 452-5999
Fax: (208) 452-4499
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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 M-11462 (ID)
Dermatology Physician Taxonomy 207N00000X · Licence M3809 (ID)

Record details

NPI number1528263670
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brock Andersen — Principal Officer · (208) 452-5999
Other names Gerald G. Overly, Md, Pa
NPI enumeratedJune 19, 2007
Last updated in NPPESFebruary 4, 2013
Mailing address1611 N Whitley Dr, Suite #7, Fruitland, ID 83619

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