NPI age
19 years
Enumerated 2007-04-10
Across 68 active podiatrist providers in Idaho.
2 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807308400 | |
| 01 (ID) | 1351211 | MEDICARE INDIVIDUAL PTAN |
| 01 (ID) | P9335 | BLUE CROSS OF IDAHO |
| 01 (ID) | 000010150955 | REGENCE BLUE SHIELD OF ID |
Doing-business-as, former, and alternate names recorded by NPPES.
Multi-provider organization. 2 individual providers on file at this primary address.
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