IndividualActive
Jon Wagnild, MD
NPI 1164459541 · Nephrology Physician · Boise, ID
Provider details
- NPI number
- 1164459541
- Entity type
- Individual
- Primary specialty
- Nephrology PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- M4213 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
5610 Gage St
Suite a
Boise, ID 83706-1349
Phone: (208) 367-3370
Approximate (ZIP-level) locationGet directions
Mailing address
984 W Bogus View Ct
Eagle, ID 83616-5878
Registry dates
- Enumerated
- 2006-06-28
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.