NPI age
10 years
Enumerated 2015-09-18
Across 32 active clinic/center providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1023487105 | |
| 05 (ID) | 1750758702 |
Multi-provider organization. 1 individual provider on file at this primary address.
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