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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:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207K00000XPhysicians
Allergy & Immunology
IDMD-2580

Other Provider Identifiers:

IssuerNumberStateType
BLUE SHIELD000010004631ID01
002516900ID05
RAILROAD MEDICARE030000684ID01
BLUE CROSS76891ID01
Code values:
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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