NPI age
19 years
Enumerated 2006-06-02
Across 22 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002649400 | |
| 01 (ID) | HB112 | BLUE CROSS OF IDAHO |
| 01 (ID) | 10004623 | REGENCE OF IDAHO |
| 05 (WA) | 8616708 |
Part of a multi-provider practice. 119 other active providers share this practice address in NPPES.
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