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General NPI Number Information
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NPI Number | 1013335157
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Entity Type | Individual
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Provider Name | WESLEY DAVID PIDCOCK DO
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Gender | Male
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Dates
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Enumeration Date | 04/05/2014
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 4400 E FLAMINGO AVE STE 200
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City | NAMPA
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State | ID
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Zip | 83687
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Country | US
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Telephone | 208-302-2100
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Fax | 208-302-2125
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE DR
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-302-2100
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Fax | 208-302-2125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | O-1353
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 20A15369
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | DO198185
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | O-1353
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License Number State | ID
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