DR. GREGORY MATHEW WICKERN (NPI# 1972578672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972578672 |
| Entity Type | Individual |
| Full Name | DR. GREGORY MATHEW WICKERN |
| Credential | M.D. |
| Practice Address |
800 Falls Ave Suite #2 Twin Falls ID 83301-3366 |
| Practice Telephone | 2087346091 |
| Practice Fax Number | 2087344654 |
| Mailing Telephone | 2087346091 |
| Mailing Fax Number | 2087344654 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2017-02-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | 13018 | NV | Allopathic & Osteopathic Physicians |
| N | 207K00000X | Allergy & Immunology | 6578473-1205 | UT | Allopathic & Osteopathic Physicians |
| Y | 207KA0200X |
Allergy & Immunology Specialization: Allergy |
M-10495 | ID | Allopathic & Osteopathic Physicians |
| Street Address |
800 FALLS AVE SUITE #2 |
| City | TWIN FALLS |
| State | ID |
| Zip Code | 83301-3366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306831045 | Gregory John Kadlec | Allergy & Immunology | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2005-09-20 |
| 1760035737 | Lara Renee Boyle | Nurse Practitioner | 800 Falls Ave, Twin Falls, ID 83301-3366 | 2019-07-18 |
| 1124224712 | K Denise Rayburn | Nurse Practitioner | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2007-06-21 |
| 1427138734 | Asthma & Allergy of Idaho Pllc | Allergy & Immunology | 800 Falls Ave, Suite 2, Twin Falls, ID 83301 | 2006-10-17 |
| 1194714717 | Winston N Petersen | Physician Assistant | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2005-10-17 |
| 1013904622 | Richard Eugene Henry | Allergy & Immunology | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2005-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023645918 | Matthew Anderson | Pharmacist | Dick's Pharmacy, 526 K Shoup Ave W, Twin Falls, ID 83301 | 2020-03-23 |
| 1780146316 | Frontier Pediatric Partners, Pllc | Pediatrics | 1502 Locust Street N #700, Twin Falls, ID 83301 | 2019-04-02 |
| 1972073377 | Wood River Acupuncture | Acupuncturist | 1625 Addison Ave East, Twin Falls, ID 83301 | 2018-11-28 |
| 1235629874 | Lonnie Paul | Counselor | 1092 Eastland Dr N Ste A, Twin Falls, ID 83301 | 2018-05-17 |
| 1679060966 | Christina Jirapha Thongdee | Social Worker | 625 Poleline Road West, Suite 2a, Twin Falls, ID 83301 | 2018-04-23 |
| 1437658499 | Tyrel Kevin Ward | Chiropractor | 2167 Village Park Ave., Suite 100, Twin Falls, ID 83301 | 2018-02-06 |
| 1851836381 | Tanabell Health Services, Inc | Skilled Nursing Facility | 1134 Cheney Drive West, Twin Falls, ID 83301 | 2016-12-19 |
| 1578005195 | Matthew Carter | Physical Therapist | 1053 Eastland Drive, Twin Falls, ID 83301 | 2016-11-14 |
| 1790227783 | Murvat Usmanova | Nurse Practitioner | 775 Pole Line Road W, Suite 203, Twin Falls, ID 83301 | 2016-11-08 |
| 1265894687 | Shawna Fultz | Social Worker | 1201 Fall Ave East Suite C, Twin Falls, ID 83301 | 2016-03-24 |
| Find all providers in zip 83301 | ||||
| Taxonomy Code | 207KA0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| Specialization | Allergy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306831045 | Gregory John Kadlec | Allergy & Immunology | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2005-09-20 |
| 1427138734 | Asthma & Allergy of Idaho Pllc | Allergy & Immunology | 800 Falls Ave, Suite 2, Twin Falls, ID 83301 | 2006-10-17 |
| 1013904622 | Richard Eugene Henry | Allergy & Immunology | 800 Falls Ave, Suite 2, Twin Falls, ID 83301-3366 | 2005-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477866606 | Idaho Allergy L.L.C. | Allergy & Immunology | 379 E Shore Dr, Suite 100, Eagle, ID 83616-5410 | 2010-07-16 |
| 1073834974 | Dallas George Rindfleisch | Allergy & Immunology | 3155 Channing Way Ste A, Idaho Falls, ID 83404-7875 | 2010-06-15 |
| 1538108089 | Kathryn L Mcmullan | Allergy & Immunology | 323 E Riverside Dr, Ste 234, Eagle, ID 83616-6864 | 2006-06-06 |
| 1306832688 | Kenneth John Wakefield | Allergy & Immunology | 3731 N Ramsey Rd, Suite 150, Coeur D Alene, ID 83815-9000 | 2005-09-22 |
| 1124462494 | Upper Valley Ent & Allergy Pllc | Allergy & Immunology | 256 N 2nd E, Rexburg, ID 83440-1638 | 2013-04-17 |
| 1376877795 | David Aaron Petty | Allergy & Immunology | 3422 S 15th E, Idaho Falls, ID 83404-8262 | 2009-10-01 |
| 1447456272 | Barry John Peterson | Allergy & Immunology | 256 N 2nd E, Rexburg, ID 83440-1638 | 2007-06-27 |
| 1972537892 | Jay Robert Mcmaster | Allergy & Immunology | 256 N 2nd E, Rexburg, ID 83440-1638 | 2006-07-10 |
| 1295769594 | David E Parry | Allergy & Immunology | 500 S 11th Ave, Suite 202, Pocatello, ID 83201-4835 | 2006-07-10 |
| 1609865880 | Charles Nephi Webb | Allergy & Immunology | 1000 N Curtis Rd, Ste 303, Boise, ID 83706-1347 | 2005-10-19 |
| Find all providers with the same taxonomy | ||||
| City | TWIN FALLS |
| Zip Code | 83301 |
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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.