NPI age
18 years
Enumerated 2007-06-28
Across 4 active pediatrics providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1154528727 | |
| 05 (TX) | 312219409 | |
| 05 (TX) | 312219410 |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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