NPI age
19 years
Enumerated 2007-01-23
Across 38 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 000010005797 | BLUE SHIELD |
| 05 (ID) | 002074200 | |
| 01 | 47209 | BLUE CROSS |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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