Greaves, Gordon Bradley

Greaves, Gordon Bradley is an sole proprietor health care provider with primary practice located at 3271 N Milwaukee St , Boise ID 83704-4425. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Greaves, Gordon Bradley can be contacted via phone (208) 996-1700.

Contact Information

Primary practice address
3271 N Milwaukee St Boise ID 83704-4425
Phone: (208) 996-1700
Fax: (208) 350-6674
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X PA615 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA615 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 16369 California

Profile Details

NPI number 1699708131
LBN Legal business name Greaves, Gordon Bradley
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 8th, 2006
Last updated Feb 2nd, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699708131 NPPES
Idaho MEDICAID 807537400
Idaho Other PA16369

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