Active NPI
Jon Parker Wagnild, MD
- Nephrology Physician
- Boise, ID
National Provider Identifier
1164459541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- M4213
- Practice address
- 5610 Gage St
Suite a
Boise, ID 83706-1349 - Phone
- (208) 367-3370
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | M4213 | ID | Primary |
Addresses
Primary practice location
5610 Gage St
Suite a
Boise, ID 83706-1349
Mailing address
984 W Bogus View CT
Eagle, ID 83616-5878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4213 | ID | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164459541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "984 W BOGUS VIEW CT",
"city": "EAGLE",
"state": "ID",
"postal_code": "836165878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5610 GAGE ST",
"address_2": "SUITE A",
"city": "BOISE",
"state": "ID",
"postal_code": "837061349",
"telephone_number": "208-367-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNILD",
"first_name": "JON",
"middle_name": "PARKER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "ID",
"license": "M4213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.