NPI age
18 years
Enumerated 2007-06-22
Across 336 active emergency medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M-11238 | LICENSE |
| 01 (NM) | RS20070377 | TRAINING |
Part of a multi-provider practice. 11 other active providers share this practice address in NPPES.
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