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

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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