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Organization
RICHARD A WATHNE, MD PA
Active
Organization
RICHARD A WATHNE, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD A WATHNE MD (PRESIDENT)
(208) 233-2100
Entity
Organization
Contact information
Practice address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Mailing address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6663
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000719
BLUE SHIELD OF ID
—
01
—
185512700
US DEPT OF LABOR
—
01
—
CG1936
RAILROAD MEDICARE
—
Enumeration date
03/01/2007
Last updated
09/07/2021
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