NPI age
19 years
Enumerated 2006-09-22
Across 11 active surgery providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (MO) | 204755102 | |
| 01 (MO) | 25911010 | BCBS KANSAS CITY |
| 05 (KS) | 100345850A | |
| 01 (KS) | 372600 | FIRSTGUARD |
Part of a multi-provider practice. 22 other active providers share this practice address in NPPES.
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