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Individual

DR. LARAMIE L. WHEELER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
2410 E 25TH ST, IDAHO FALLS, ID 83404
(208) 557-0200
(208) 542-5080
Mailing address
2410 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 557-0200
(208) 542-5080

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-0426
ID
390200000X
Student in an Organized Health Care Education/Training Program
MR0836
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807243000
ID
Enumeration date
08/30/2005
Last updated
08/22/2018
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