NPI age
19 years
Enumerated 2006-07-08
● Active
Type 1 · Individual
Gordon Bradley Greaves, PA
Greaves is 1 of 1 physician assistant providers in Wilder and 1 of 1263 in Idaho.
Primary specialty
Physician Assistant
Plus 2 subspecialties
Licensed in
ID, CA
2 states
Status
Active
No deactivations on record
Last NPPES update
2025-04-14
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 1263 active physician assistant providers in Idaho.
NPI age
19 years
↑ 10 yr above median (9 yr)
State licenses
2 states
Top 81% — 19% of peers are multi-state
Subspecialties
1
In the 35% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-07Enumerated in NPPES
2006
2026
Where they practice
Practice location
15821 Allendale Rd
Wilder, ID 836765864
Mailing address
15821 Allendale Rd
Wilder, ID 836765864
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
-
Nurse PractitionerDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807537400 | |
| 01 (CA) | 16369 | PA LICENSE |
| 01 (ID) | PA615 | IDAHO BOARD OF MEDICINE |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.