NPI age
20 years
Enumerated 2005-05-27
Across 111 active internal medicine providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 | 710949800 | COMMERCIAL |
| 05 (ID) | 002708700 |
Part of a multi-provider practice. 13 other active providers share this practice address in NPPES.
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