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IDAHO FALLS DERMATOLOGY, P.A.

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Company Details

Name: IDAHO FALLS DERMATOLOGY, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 19 Aug 1991 (34 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 297710
Place of Formation: IDAHO
File Number: 297710
ZIP code: 83404
County: Bonneville County
Mailing Address: STE 12A 2001 S WOODRUFF AVE IDAHO FALLS, ID 83404-6372

Agent

Name Role Address
PAUL BROOKE, M.D. Agent 2001 S. WOODRUFF, STE 12A, IDAHO FALLS, ID 83404

Secretary

Name Role Address Appointed On
Margo Brooke Secretary 6229 HIGHWAY 12 WEST, HELENA, MT 89601 2021-03-02

President

Name Role Address Appointed On Resigned On
C Paul Brooke President 2001 S WOODRUFF AVE, IDAHO FALLS, ID 83404 2020-07-07 2021-03-02
Paul Brooke MD President 2001 S WOODRUFF, IDAHO FALLS, ID 83404 2023-07-11 No data

National Provider Identifier

NPI Number:
1487700464

Authorized Person:

Name:
CORNELIUS PAUL BROOKE
Role:
M.D.
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
820445241
Plan Year:
2023
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
9
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
7
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005796299 2024-07-03
Annual Report 0005315842 2023-07-11
Annual Report 0004805095 2022-07-05
Annual Report 0004336314 2021-07-07
Annual Report Amendment 0004187437 2021-03-02

USAspending Awards / Financial Assistance

Date:
2020-04-29
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
59800.00
Total Face Value Of Loan:
59800.00

Paycheck Protection Program

Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
59800
Current Approval Amount:
59800
Race:
White
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
60312.81

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Date of last update: 01 Jun 2025

Sources: Idaho Secretary of State