Individual
DR. BRANDON D WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1455 BENCH RD STE B, POCATELLO, ID 83201-5084
(208) 232-0006
(208) 233-8771
Mailing address
1455 BENCH RD, SUITE B, POCATELLO, ID 83201-5083
(208) 232-0006
(208) 233-8771
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P-217
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407169865
—
MO
01
—
P01271994
RAILROAD MEDICARE
MO
Enumeration date
07/14/2010
Last updated
03/05/2026
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