Individual
JOEL B. WHITING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3300 WASHINGTON PARKWAY, IDAHO FALLS, ID 83404-7592
(208) 522-6662
(208) 522-0880
Mailing address
3300 WASHINGTON PARKWAY, IDAHO FALLS, ID 83404-7592
(208) 522-6662
(208) 522-0880
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1838
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010163120
BLUE SHIELD OF IDAHO
ID
01
—
PAF74
BLUE CROSS OF IDAHO
ID
Enumeration date
08/07/2006
Last updated
03/13/2008
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