MEDICARE: BRENT BLUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3416A	WY
2	207P00000X	Emergency Medicine Physician	A31472	CA
3	261QU0200X	Urgent Care Clinic/Center	3416A	WY

General Provider Information

NPI Number	:	1063467538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT BLUE MD

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	WILSON
State	:	WY
Zip	:	83014-0025
Country	:	US
Telephone Number	:	307-733-7835
Fax Number	:	307-201-4999

Provider Business Practice Location Address
First Line	:	190 MUSTANG DRIVE
Second Line	:
City	:	DRIGGS
State	:	ID
Zip	:	83422-0000
Country	:	US
Telephone Number	:	307-733-7835
Fax Number	:	307-201-4999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/06/2026

Similar Medicare Providers

1356556518 — BRENT BLUE MD
Practice Location Address:

190 MUSTANG DRIVE
DRIGGS, ID
83422-0000

Practice Phone: 307-733-7835
Practice Fax: 307-201-4999

1063671238 — KLADUKE INC
Practice Location Address:

35 N 1ST ST
DRIGGS, ID
83422-0000

Practice Phone: 208-354-5775
Practice Fax:

1457021743 — ROCKY MOUNTAIN HOLDINGS, LLC
Practice Location Address:

253 WARBIRD LANE
DRIGGS, ID
83422-0000

Practice Phone: 888-636-4438
Practice Fax:

1811211527 — MISSY RENEE STURK M.S., OTR/L
Practice Location Address:

76 N MAIN ST
DRIGGS, ID
83422-5125

Practice Phone: 208-520-5672
Practice Fax:

1235128877 — DR. DEBRA M WHIPPLE FNP-BC
Practice Location Address:

3246 N 1500 E
DRIGGS, ID
83422

Practice Phone: 801-814-7567
Practice Fax:

1396715371 — TROY D WESTON PA
Practice Location Address:

120 E HOWARD ST , TETON VALLEY HEALTH CARE
DRIGGS, ID
83422-5112

Practice Phone: 208-354-6302
Practice Fax: 208-354-3158

Directions to “ BRENT BLUE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.