NPI age
13 years
Enumerated 2012-05-26
Across 111 active internal medicine providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (MO) | 000015401 | MEDICARE |
| 05 (MO) | 507013605 |
Part of a multi-provider practice. 29 other active providers share this practice address in NPPES.
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