GORDON BRADLEY GREAVES

WILDER, ID
NPI1699708131
Other NameG BRAD GREAVES
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA615)
Additional Taxonomies363A00000X Physician Assistant
(Licence: CA  16369)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: ID  PA615)
Enumeration Date2006-07-08
Last Update Date2025-01-08
Business Address
GORDON BRADLEY GREAVES PA
15821 ALLENDALE RD
WILDER, ID 83676-5864
Phone number: 801-664-1757
Mailing Address
GORDON BRADLEY GREAVES PA
15821 ALLENDALE RD
WILDER, ID 83676-5864
Phone number: 801-664-1757