NPI age
13 years
Enumerated 2012-06-25
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (AZ) | 032402 | |
| 01 (AZ) | R73512 | TRAINING PERMIT |
Part of a multi-provider practice. 31 other active providers share this practice address in NPPES.
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