Healthcare Provider Details

I. General information

NPI: 1760520951
Provider Name (Legal Business Name): GREGORY E BIDDULPH ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WASHINGTON PKWY
IDAHO FALLS ID
83404-7592
US

IV. Provider business mailing address

3300 WASHINGTON PKWY
IDAHO FALLS ID
83404-7592
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-6662
  • Fax: 208-522-0880
Mailing address:
  • Phone: 208-522-6662
  • Fax: 208-522-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateID

VIII. Authorized Official

Name: GREGORY E BIDDULPH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 208-522-6662