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General NPI Number Information
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NPI Number | 1427138734
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Entity Type | Organization
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Legal Business Name | ASTHMA & ALLERGY OF IDAHO PLLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 1502 LOCUST ST N STE 600
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City | TWIN FALLS
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State | ID
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Zip | 83301-4164
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Country | US
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Telephone | 208-734-6091
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Fax | 208-734-4654
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Provider Business Mailing Address
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Address Line | 1502 LOCUST ST N STE 600
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City | TWIN FALLS
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State | ID
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Zip | 83301-4164
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Country | US
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Telephone | 208-734-6091
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Fax | 208-734-4654
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ANDREW WICKERN
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Credential |
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Telephone | 208-734-6091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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