NPI age
18 years
Enumerated 2008-01-30
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (KS) | PENDING | LICENSE |
| 01 (CO) | 2007018939 | LICENSE |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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