NPI age
20 years
Enumerated 2006-05-18
Across 48 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1124071592 | |
| 05 (WA) | 1002988 |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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