NPI age
20 years
Enumerated 2005-07-07
Across 1691 active family medicine providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010001249 | REGENCE BLUE SHIELD PROV |
| 01 | 080075556 | RAILROAD MEDICARE PROV# |
| 05 (WA) | 1003592 | |
| 01 (ID) | 1139282 | IDAHO MEDICARE PROV # |
| 01 | 193254001 | OWCP PROV # |
| 01 (WA) | 1095264 | WASH MEDICAID PROV # |
| 01 (ID) | 71993 8J935 | BLUE CROSS IDAHO PROV# |
| 01 (WA) | 104012 | DL&I PROV NUMBER |
| 05 (ID) | 1154328052 | |
| 05 (ID) | 003310000 |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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