NPI age
19 years
Enumerated 2007-01-11
Across 152 active anesthesiology providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1003966227 | |
| 01 (MT) | 11302 | MONTANA LICENSE NUMBER |
| 01 (ID) | M11396 | IDAHO MEDICAL LICENSE |
Part of a multi-provider practice. 144 other active providers share this practice address in NPPES.
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