NPI age
19 years
Enumerated 2007-01-14
Across 387 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (CO) | P00750757 | RR MEDICARE |
| 05 (ID) | 1255482683 | |
| 05 (CO) | 82377774 |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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