Individual
BRYCE WIKFORS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
206 E ELM ST, CALDWELL, ID 83605-4815
(208) 459-4511
Mailing address
206 E ELM ST, CALDWELL, ID 83605-4815
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-996
ID
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
09/21/2012
Last updated
02/10/2021
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