DR. WENDELL E PETTY


Address: 3422 S 15th E, Idaho Falls, ID 83404-8262
Phone: 2085299292

DR. WENDELL E PETTY (NPI# 1457312308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1457312308
Entity Type Individual
Full Name DR. WENDELL E PETTY
Other Name DR. GENE PETTY
Credential M.D.
Practice Address 3422 S 15th E
Idaho Falls
ID 83404-8262
Practice Telephone 2085299292
Practice Fax Number 2085256013
Mailing Telephone 2085299292
Mailing Fax Number 2085256013
Enumeration Date 2006-03-30
Last Update Date 2019-06-21
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207K00000X Allergy & Immunology MD-2580 ID Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
ID BLUE SHIELD 000010004631 01
ID 002516900 05
ID RAILROAD MEDICARE 030000684 01
ID BLUE CROSS 76891 01

Office Location

Street Address 3422 S 15TH E
City IDAHO FALLS
State ID
Zip Code 83404-8262

Providers in the same location

NPI Name Taxonomy Address Enumeration
1285621532 Michael T Harris Md, PC Clinic/Center 3422 S 15th E, Idaho Falls, ID 83404-8262 2005-10-03
1760044424 Phillip Marlowe Radiologic Technologist 3422 S 15th E, Idaho Falls, ID 83404-8262 2019-07-02
1215314968 Hsiang-hua Wang Counselor 3422 S 15th E, Idaho Falls, ID 83404-8262 2015-05-01
1114343985 Kelly Stark Counselor 3422 S 15th E, Idaho Falls, ID 83404-8262 2014-03-17
1912335738 Family Resource Centers of America, Inc Clinic/Center 3422 S 15th E, Idaho Falls, ID 83404-8262 2013-10-15
1164712899 Sawtooth Rehab, Pllc Specialist 3422 S 15th E, Idaho Falls, ID 83404-8262 2011-04-14
1720387681 Travis Scott Hull Social Worker 3422 S 15th E, Idaho Falls, ID 83404-8262 2011-03-17
1376877795 David Aaron Petty Allergy & Immunology 3422 S 15th E, Idaho Falls, ID 83404-8262 2009-10-01
1235363169 Maria Teresa Alvarado Counselor 3422 S 15th E, Idaho Falls, ID 83404-8262 2009-05-06
1982841334 Karen Elise Bender Registered Nurse 3422 S 15th E, The Healing Sanctuary, Idaho Falls, ID 83404-8262 2009-01-07
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437750809 Joshua M Murphy Dentist 1580 Elk Creek Dr., Idaho Falls, ID 83404 2020-11-03
1427618958 Eastern Idaho Endodontics Dentist 3335 S. Holmes Ave, Idaho Falls, ID 83404 2019-06-17
1942863600 Muhammad Arslan Khan Student in an Organized Health Care Education/Training Program 2860 Channing Way Suite 214, Idaho Falls, ID 83404 2019-04-18
1942771043 Physician's Choice Cardiology, Pllc Internal Medicine 3302 Valencia, Suite 201, Idaho Falls, ID 83404 2018-12-16
1609358761 Cardiac Cath Lab of Idaho Falls Internal Medicine 3311 Valencia Drive, Idaho Falls, ID 83404 2018-09-05
1083196380 Hannah Golden Occupational Therapist 1460 Elk Creek, Idaho Falls, ID 83404 2018-09-04
1316423049 Lindsay Sessions Speech-Language Pathologist 2210 Niagara St, Idaho Falls, ID 83404 2018-07-16
1720574023 Bmh, Inc. Anesthesiology 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 2018-07-10
1093237935 Jason Earl Bailey Contractor 3100 S Woodruff Ave., Idaho Falls, ID 83404 2017-07-12
1235682121 Mountain Falls Quick Care Clinic/Center 1995 E 17th St #1, Idaho Falls, ID 83404 2016-07-27
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Taxonomy Information

Taxonomy Code 207K00000X
Grouping Allopathic & Osteopathic Physicians
Classification Allergy & Immunology

Taxonomy Definition

An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system.
Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1003949298 Idaho Allergy & Asthma Clinic Pa Allergy & Immunology 3422 S 15th E, Idaho Falls, ID 83404-8262 2007-03-14

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1396972311 Jeremy David Waldram Allergy & Immunology 1000 N Curtis Rd Ste 303, Boise, ID 83706-1347 2009-06-17
1679569149 Michael V Keiley Allergy & Immunology 901 N Curtis Rd, Ste 100, Boise, ID 83706-1394 2005-09-21
1215061734 Boise Valley Asthma & Allergy Pa Allergy & Immunology 901 N Curtis Rd, Suite 100, Boise, ID 83706-1394 2007-03-15
1316979974 Allergy Group PC Allergy & Immunology 1000 N Curtis Rd, Ste 303, Boise, ID 83706 2006-07-06
1972578672 Gregory Mathew Wickern Allergy & Immunology 800 Falls Ave, Suite #2, Twin Falls, ID 83301-3366 2006-02-17
1417943622 John D Jeppson Allergy & Immunology 901 N Curtis Rd, Suite 100, Boise, ID 83706-1394 2005-09-22
1033105259 George William Palmer Allergy & Immunology 901 N Curtis Rd, Ste 100, Boise, ID 83706-1394 2005-09-22

Competitor

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City IDAHO FALLS
Zip Code 83404

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Dataset Information

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.

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