Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gordon Bradley Greaves, PA

Individual provider Physician Assistant · NPI 1699708131

Gordon Bradley Greaves, PA is a Physician Assistant in Wilder, Idaho. Qualified in 2002, 24 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in California and Idaho.

Years since qualifying
24
Licensed in
CA, ID
In the registry since
2006
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

15821 Allendale Rd
Wilder, ID 83676-5864
Phone: (208) 278-2863
Fax: (208) 621-3128
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA615 (ID)
Physician Assistant Taxonomy 363A00000X · Licence 16369 (CA)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence PA615 (ID)

Record details

NPI number1699708131
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJuly 8, 2006
Last updated in NPPESApril 14, 2025
Certification dateApril 14, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount