Healthcare Provider Details

I. General information

NPI: 1255399820
Provider Name (Legal Business Name): WARREN WILLIAM GUDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROBBINS ROAD THE CENTER FOR WOUND HEALING AND HYPERBARIC MEDICINE
BOISE ID
83702
US

IV. Provider business mailing address

600 ROBBINS ROAD THE CENTER FOR WOUND HEALING AND HYPERBARIC MEDICINE
BOISE ID
83702
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-5800
  • Fax: 208-489-4060
Mailing address:
  • Phone: 208-489-5800
  • Fax: 208-489-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberK0792
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberM-9881
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberMD153967
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberM9881
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: