NPI age
19 years
Enumerated 2006-06-15
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002695400 | |
| 01 (ID) | 1300707 | MEDICARE PART B |
| 01 (OR) | 135457 | MEDICARE PART B |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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