NPI age
12 years
Enumerated 2013-10-30
Across 1263 active physician assistant providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (UT) | 1215365150 |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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