Healthcare Provider Details

I. General information

NPI: 1548222516
Provider Name (Legal Business Name): SETH N WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 POLE LINE RD W SUITE 203
TWIN FALLS ID
83301-5814
US

IV. Provider business mailing address

PO BOX 587
TWIN FALLS ID
83303-0587
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-8300
  • Fax: 208-733-8970
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM9629
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: