Brandon Dean Wilde (NPI# 1407169865, PAC ID# 1456508746) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.
| Nation Provider ID (NPI) | 1407169865 |
| PAC ID by PECOS | 1456508746 |
| Professional Enrollment ID | I20120821000635 |
| Full Name | Brandon Dean Wilde |
| Address |
1455 Bench Rd Suite B Pocatello ID 83201-5084 |
| Gender | M |
| Medical School | COLLEGE PODIATRIC MEDICINE AND SURGERY UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES |
| Graduation Year | 2009 |
| Primary Specialty | PODIATRY |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 131305 | STEELE MEMORIAL MEDICAL CENTER |
| 130028 | PORTNEUF MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1455 Bench Rd, Suite B, Pocatello, ID 83201-5084 |
| Street Address |
1455 BENCH RD SUITE B |
| City | POCATELLO |
| State | ID |
| Zip | 83201-5084 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Timothy A Flicker | Physical Therapy | 2839 Margo Ln, Pocatello, ID 83201-1961 | |
| Michael D Lance | Psychiatry | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Kenneth A Cogen | Nephrology | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Randall J Skeem | Internal Medicine | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Martha Elizabeth Franz | Family Practice | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| John L Shuss | General Surgery | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Ciara C Christensen | Clinical Psychologist | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Robin L Hall | Nurse Practitioner | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Laurence L Martens | Family Practice | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Terry J Buccambuso | Diagnostic Radiology | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Find all physicians in zip 83201 | |||
| City | POCATELLO |
| Zip Code | 83201 |
| Specialty | PODIATRY |
| City + Specialty | POCATELLO + PODIATRY |
Please comment or provide details below to improve the information on Brandon Dean Wilde.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.