Organization
VALLEY FOOT & ANKLE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON DEAN WILDE DPM (OWNER/PRACTIONER)
(208) 232-0006
Entity
Organization
Contact information
Practice address
1455 BENCH RD STE B, POCATELLO, ID 83201-5084
(208) 232-0006
(208) 232-0006
Mailing address
1455 BENCH RD STE B, POCATELLO, ID 83201-5084
(208) 232-0006
(208) 233-8771
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P92
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000806000
—
ID
05
—
804267100
—
ID
05
—
806528400
—
ID
Enumeration date
02/20/2007
Last updated
03/17/2018
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