NPI age
19 years
Enumerated 2006-07-08
Across 1691 active family medicine providers in Idaho.
5 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | DG4201 | RR MEDICARE |
| 05 (ID) | 807644700 |
Multi-provider organization. 5 individual providers on file at this primary address.
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