Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
GORDON BRADLEY GREAVES, PA
Active Sole ProprietorGORDON BRADLEY GREAVES, PA is a Physician Assistant healthcare provider located in WILDER, Idaho. NPI 1699708131 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · WILDER, ID
Registration Details
- NPI Number
- 1699708131
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 8, 2006 (20.094949695078 yrs)
- Last Updated
- Apr 14, 2025
- Licenses
-
16369 (CA)PA615 (ID)PA615 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
15821 ALLENDALE RDWILDER, ID, 836765864Browse ID providers · Browse ZIP 83676
- Phone
- 2082782863
- Fax
- 2086213128
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- Psychiatric/Mental Health Nurse Practitioner
- Additional Specialty
- Physician Assistant
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.