NPI age
20 years
Enumerated 2006-01-23
Across 260 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807416500 | |
| 05 (WA) | 1122811 | |
| 01 (ID) | P00304529 | RR MEDICARE |
| 01 (ID) | 76588 | BC ID |
Part of a multi-provider practice. 11 other active providers share this practice address in NPPES.
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