Individual provider · NPI-1
Garrett Coman, M.D.
Dermatology · Ketchum, ID
NPI number1306209556
StatusActive
Last updated in NPPESJun 29, 2020
Details
- NPI
- 1306209556
- Entity type
- Individual (NPI-1)
- Name
- Garrett Coman
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 4, 2016
- Certification date
- Jun 29, 2020
- Last updated
- Jun 29, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | M-15211 | ID | Yes |
Practice location
St. Luke'S Dermatology191 5th Street West
Ketchum, ID 83340
Phone 208-725-2171
Mailing address
University Hospital30 N 1900 E Room 4c104
Salt Lake City, UT 84132
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