NPI age
17 years
Enumerated 2008-09-08
Across 1263 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1184872632 | |
| 01 (ID) | PA-766 | PHYSICIAN ASSISTANT LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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