NPI age
19 years
Enumerated 2006-08-19
Across 252 active pediatrics providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (MT) | 0117390 | |
| 01 (ID) | 000010147366 | BLUE SHIELD |
| 01 (ID) | 70987 | BLUE CROSS |
| 05 (ID) | 806891000 | |
| 05 (WY) | 123958900 | |
| 05 (WY) | 1285786046 |
Part of a multi-provider practice. 12 other active providers share this practice address in NPPES.
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