NPI age
19 years
Enumerated 2006-06-29
Across 260 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 020048945 | MCRR - SIGS |
| 01 (ID) | P00721163 | MCRR - SLC |
| 05 (ID) | 000369200 |
Part of a multi-provider practice. 58 other active providers share this practice address in NPPES.
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