MEDICARE: BRETT W ZUNDEL P.A-C

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	363AM0700X	Medical Physician Assistant	PA197	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007309726	OTHER	ID	AETNA
2	000010006458	OTHER	ID	BLUE SHIELD
3	PAYL7	OTHER	ID	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730222365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT W ZUNDEL P.A-C

Provider Business Mailing Address
First Line	:	39 N 8TH W
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-1337
Country	:	US
Telephone Number	:	208-419-6423
Fax Number	:	208-379-3520

Provider Business Practice Location Address
First Line	:	39 N 8TH W
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-1337
Country	:	US
Telephone Number	:	208-419-6423
Fax Number	:	208-379-3520

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	02/10/2026

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