Individual
CASI MCPHERSON WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
125 E IDAHO ST, SUITE 203, BOISE, ID 83712-6212
(208) 338-0148
(208) 336-4027
Mailing address
125 E IDAHO ST, SUITE 203, BOISE, ID 83712-6212
(208) 338-0148
(208) 336-4027
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
3714
IA
207RI0200X
Infectious Disease Physician
Primary
O-0530
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0731364
—
IA
01
—
26705
WELLMARK BCBS
IA
Enumeration date
09/01/2006
Last updated
06/09/2009
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