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Individual

DR. WAYNE L HOLLOPETER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
721 W. NORTH STREET, GRANGEVILLE, ID 83530
(208) 983-0300
(208) 983-9176
Mailing address
721 W. NORTH STREET, GRANGEVILLE, ID 83530
(208) 983-0300
(208) 983-9176

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3216
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010001613
REGENCE BLUESHIELD OF IDA
ID
01
32169
BLUECROSS OF IDAHO
ID
Enumeration date
10/03/2006
Last updated
07/08/2007
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