NPI age
19 years
Enumerated 2006-09-27
Across 1691 active family medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M6388 | STATE LICENSE # |
| 05 (ID) | 003900500 | |
| 01 (ID) | 000010000817 | BLUE SHIELD OF IDAHO ID# |
Part of a multi-provider practice. 66 other active providers share this practice address in NPPES.
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.
Request a quote →