DR. BRANDON D WILDE (NPI# 1407169865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407169865 |
| Entity Type | Individual |
| Full Name | DR. BRANDON D WILDE |
| Credential | D.P.M. |
| Practice Address |
1455 Bench Rd Ste B Pocatello ID 83201-5084 |
| Mailing Address |
1455 Bench Rd Suite B Pocatello ID 83201-5083 |
| Practice Telephone | 2082320006 |
| Practice Fax Number | 2082338771 |
| Mailing Telephone | 2082320006 |
| Mailing Fax Number | 2082338771 |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2017-11-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
P-217 | ID | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1407169865 | 05 | |
| MO | RAILROAD MEDICARE | P01271994 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710140447 | Brandon J Wilde | Counselor | 4460 Central Way, Suite 2, Chubbuck, ID 83202 | 2008-07-02 |
| Street Address |
1455 BENCH RD STE B |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-5084 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669516738 | Valley Foot & Ankle, PC | Podiatrist | 1455 Bench Rd Ste B, Pocatello, ID 83201-5084 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245216647 | Kert W Howard | Podiatrist | 1555 E Clark St, Pocatello, ID 83201-4133 | 2005-12-16 |
| 1992093561 | Karson Kert Howard | Podiatrist | 1555 E Clark St, Pocatello, ID 83201-4133 | 2011-07-18 |
| 1912194085 | Pocatello Podiatry Associates Pa | Podiatrist | 1555 E Clark St, Pocatello, ID 83201-4133 | 2007-10-02 |
| 1669676276 | S. Jeff Bray, Dpm, Inc. | Podiatrist | 2240 E Center St, Pocatello, ID 83201-2600 | 2007-06-14 |
| 1386721637 | Steven Jeff Bray | Podiatrist | 2240 E Center St, Pocatello, ID 83201-2600 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518225929 | Clark A Johnson | Podiatrist | 3120 W Belltower Dr Ste 100, Meridian, ID 83646-7744 | 2012-04-24 |
| 1396023446 | Kurt Earl Kinghorn | Podiatrist | 1828 S Millenium Way Ste 200, Meridian, ID 83642-5036 | 2011-07-22 |
| 1649506536 | James Rex Cutler | Podiatrist | 76 E 1st S, Rexburg, ID 83440-1936 | 2009-10-27 |
| 1174756316 | Daniel Matthew Wettstein | Podiatrist | 476 Cheney Drive West, Twin Falls, ID 83301 | 2009-09-03 |
| 1578576732 | Bruce G Tolman | Podiatrist | 1540 Elk Creek Dr, Idaho Falls, ID 83404-8322 | 2006-08-15 |
| 1679514186 | Ryan Averett Dpm PC | Podiatrist | 2221 W Ironwood Center Dr, Coeur D Alene, ID 83814-2697 | 2006-06-08 |
| 1093717787 | Richard Michael Allen | Podiatrist | 1630 23rd Ave, Suite 1001, Lewiston, ID 83501-6350 | 2005-08-11 |
| 1447257076 | Bradley J Capawana | Podiatrist | 619 S Washington St, Ste 103, Moscow, ID 83843-3090 | 2005-06-28 |
| 1326042045 | Michael J Drager | Podiatrist | 850 W Ironwood Dr, Ste 301, Coeur D Alene, ID 83814-4903 | 2005-06-09 |
| 1083261697 | Treasure Valley Foot and Ankle | Podiatrist | 3120 W Belltower Dr Ste 100, Meridian, ID 83646-7744 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.