Organization
TREASURE VALLEY CARDIOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRAHAM WETHERLEY M.D. (PRESIDENT)
(208) 322-1686
Entity
Organization
Contact information
Practice address
900 N LIBERTY ST, SUITE 302, BOISE, ID 83704-8704
(208) 322-1686
Mailing address
PO BOX 9589, BOISE, ID 83707-4589
(208) 472-8117
(208) 472-8172
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M5449
ID
363L00000X
Nurse Practitioner
NP642A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002180300
—
ID
05
—
807805900
—
ID
Enumeration date
07/09/2006
Last updated
11/17/2014
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