Individual
GORDON BRADLEY GREAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
15821 ALLENDALE RD, WILDER, ID 83676-5864
(208) 278-2863
(208) 621-3128
Mailing address
15821 ALLENDALE RD, WILDER, ID 83676-5864
(208) 278-2863
(208) 621-3128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
16369
CA
363A00000X
Physician Assistant
Primary
PA615
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
PA615
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16369
PA LICENSE
CA
05
—
807537400
—
ID
01
—
PA615
IDAHO BOARD OF MEDICINE
ID
Enumeration date
07/08/2006
Last updated
04/14/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us