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Individual

DR. GLENN R. WAITE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
232 S WHISPERWOOD WAY, BOISE, ID 83709-4900
(208) 350-6450
(208) 350-6449
Mailing address
232 S WHISPERWOOD WAY, BOISE, ID 83709-4900
(208) 350-6450
(208) 350-6449

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23679
CO
207Q00000X
Family Medicine Physician
8577
NV
207Q00000X
Family Medicine Physician
A38237
CA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
M-11148
ID
2081P0004X
Spinal Cord Injury Medicine Physician
23679
CO
2081P0004X
Spinal Cord Injury Medicine Physician
8577
NV
2081P0004X
Spinal Cord Injury Medicine Physician
A38237
CA

Other

Enumeration date
08/02/2006
Last updated
06/25/2014
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