Idaho Allergy & Asthma Clinic PA

NPI #1003949298 in Idaho Falls, Idaho

Provider Information

NPI Number: 1003949298
Entity Type: Organization
Organization Name: Idaho Allergy & Asthma Clinic PA
Primary Specialty: Allergy & Immunology
Enumeration Date: Mar 14, 2007
Last Updated: Jun 21, 2019

Practice Location

Address: 3422 S 15TH E
City: Idaho Falls
State: Idaho
ZIP Code: 83404-8262
Phone: (208) 529-9292

Authorized Official

Name: DR. WENDELL E PETTY, M.D.
Title: PRESIDENT
Phone: (208) 529-9292

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Allergy & Immunology	207K00000X	Primary

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