DR. WENDELL E PETTY M.D.
Allergy and Immunology
Idaho Falls, Idaho
Provider NPI: 1457312308
Provider Information:DR. WENDELL E PETTY M.D.
Practice Location:
3422 S 15TH E IDAHO FALLS, ID 83404 US
Tel: 208-529-9292 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 207K00000X | Physicians Allergy & Immunology | ID | MD-2580 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
BLUE SHIELD | 000010004631 | ID | 01 |
002516900 | ID | 05 | |
RAILROAD MEDICARE | 030000684 | ID | 01 |
BLUE CROSS | 76891 | ID | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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