NPI age
19 years
Enumerated 2007-03-28
Across 19 active obstetrics & gynecology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M3119 | IDAHO STATE LICENSE |
| 01 (ID) | 01602650631 | AMA MEMBERSHIP |
| 01 (ID) | 13D0521509 | CLIA LAB ID NUMBER |
| 05 (ID) | 002523800 | |
| 01 (ID) | MD1637 | IDAHO CONTROLLED SUBSTANC |
| 01 (ID) | 000010000709 | REGENCE BLUE SHIELD OF ID |
| 01 (OR) | 140277 | OMAP OREGON MEDICAID |
| 01 (ID) | 50120 | BLUE CROSS OF IDAHO |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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