# IDAHO ALLERGY & ASTHMA CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003949298
- **Authorized official:** DR. WENDELL E PETTY M.D. (PRESIDENT)
- **Authorized official phone:** (208) 529-9292

## Contact information

- **Practice address:** 3422 S 15TH E, IDAHO FALLS, ID 83404-8262
- **Practice address phone:** (208) 529-9292
- **Practice address fax:** (208) 523-2397
- **Mailing address:** 3422 S 15TH E, IDAHO FALLS, ID 83404-8262
- **Mailing address phone:** (208) 529-9292
- **Mailing address fax:** (208) 523-2397

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 06/21/2019