NPI age
19 years
Enumerated 2006-11-02
Across 102 active dermatology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M-6227 | STATE MED LICENSE |
| 01 (CA) | G-49757 | STATE MED LICENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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