Petty, Wendell E

Petty, Wendell E is an individual health care provider with primary practice located at 3422 S 15Th E , Idaho Falls ID 83404-8262. He recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy & Immunology, which is considered as his primary health care specialty. Petty, Wendell E can be contacted via phone (208) 529-9292.

Contact Information

Primary practice address
3422 S 15Th E Idaho Falls ID 83404-8262
Phone: (208) 529-9292
Fax: (208) 525-6013
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X MD-2580 Idaho

Profile Details

NPI number 1457312308
LBN Legal business name Petty, Wendell E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2006
Last updated Jun 21st, 2019 - about 5 years ago

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 1457312308 NPPES
Idaho Other 76891 BLUE CROSS
Idaho Other 000010004631 BLUE CROSS
Idaho MEDICAID 002516900 BLUE CROSS
Idaho Other 030000684 BLUE CROSS

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