IndividualActive
Wendell Petty, M.D.
NPI 1457312308 · Allergy & Immunology Physician · Idaho Falls, ID
Provider details
- NPI number
- 1457312308
- Entity type
- Individual
- Primary specialty
- Allergy & Immunology PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- MD-2580 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3422 S 15th E
Idaho Falls, ID 83404-8262
Phone: (208) 529-9292
Fax: (208) 525-6013
Approximate (ZIP-level) locationGet directions
Mailing address
3422 S 15th E
Idaho Falls, ID 83404-8262
Registry dates
- Enumerated
- 2006-03-30
- Last updated
- 2019-06-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.