Individual
DR. GREGORY MATHEW WICKERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1502 LOCUST ST N STE 600, TWIN FALLS, ID 83301-4164
(208) 734-6091
(208) 734-4654
Mailing address
800 FALLS AVE, SUITE #2, TWIN FALLS, ID 83301-3366
(208) 734-6091
(208) 734-4654
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
13018
NV
207K00000X
Allergy & Immunology Physician
6578473-1205
UT
207KA0200X
Allergy Physician
Primary
M-10495
ID
Other
Enumeration date
02/17/2006
Last updated
11/17/2020
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