Individual
ERIC A WINGERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1995 E 17TH ST, ST. #4, IDAHO FALLS, ID 83404-6493
(208) 524-3939
(208) 524-3950
Mailing address
1995 E 17TH ST, ST. #4, IDAHO FALLS, ID 83404-6493
(208) 524-3939
(208) 524-3950
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0-122
ID
207RG0100X
Gastroenterology Physician
MEDPHYSCOMLIC114155
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002708700
—
ID
01
—
710949800
COMMERCIAL
—
Enumeration date
05/27/2005
Last updated
01/02/2024
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