Individual
DR. IVAN D PETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
90 HOPE DR, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7900
Mailing address
90 HOPE DR, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2019-01392
NC
2083A0100X
Aerospace Medicine Physician
2019-01392
NC
Other
Enumeration date
05/26/2016
Last updated
09/12/2025
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