Provider Demographics
NPI:1255399820
Name:GUDE, WARREN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:WILLIAM
Last Name:GUDE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ROBBINS ROAD
Mailing Address - Street 2:THE CENTER FOR WOUND HEALING AND HYPERBARIC MEDICINE
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-489-5800
Mailing Address - Fax:208-489-4060
Practice Address - Street 1:600 ROBBINS ROAD
Practice Address - Street 2:THE CENTER FOR WOUND HEALING AND HYPERBARIC MEDICINE
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-489-5800
Practice Address - Fax:208-489-4060
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0792207PE0004X
IDM-9881207PE0004X
ORMD153967207PE0005X
IDM9881207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120628604Medicaid
TX84V219Medicare ID - Type Unspecified
TX120628604Medicaid
F90049Medicare UPIN