NPI age
19 years
Enumerated 2006-08-20
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (MT) | 000096575 | BLUE CROSS BS |
| 05 (ID) | 807560000 | |
| 05 (MT) | 0069207 |
Part of a multi-provider practice. 34 other active providers share this practice address in NPPES.
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