NPI age
13 years
Enumerated 2012-07-03
Across 1691 active family medicine providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ME) | E400232990 | MEDICARE PTAN |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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