NPI age
20 years
Enumerated 2005-09-09
Across 32 active internal medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 56283 | BLUE CROSS OF IDAHO |
| 05 (ID) | 000476900 | |
| 01 (ID) | 000010000054 | REGENCE BLUE SHIELD OF ID |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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