Provider Demographics
NPI:1760520951
Name:GREGORY E BIDDULPH ORTHOPEDICS
Entity Type:Organization
Organization Name:GREGORY E BIDDULPH ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIDDULPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-522-6662
Mailing Address - Street 1:3300 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7592
Mailing Address - Country:US
Mailing Address - Phone:208-522-6662
Mailing Address - Fax:208-522-0880
Practice Address - Street 1:3300 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7592
Practice Address - Country:US
Practice Address - Phone:208-522-6662
Practice Address - Fax:208-522-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID77075OtherBLUE CROSS OF IDAHO
UTZ4950OtherBUREAU OF MEDICAID
286007OtherOREGON MEDICAID
20036025OtherRAIL ROAD MEDICARE
ID000010163002OtherBLUE SHIELD OF IDAHO
29686OtherBXI
CA8157532OtherOUT OF STATE CLAIMS DEPAR
ID0027971Medicaid
ID0000100000552OtherMEDIVANTAGE BS
196973OtherALTIUS
VA613028OtherBX BS OF VIRIGINIA
NC7608951OtherEDS OF NORTH CAROLINA
ID1134561Medicare PIN
ID0000100000552OtherMEDIVANTAGE BS