NPI age
19 years
Enumerated 2006-09-26
Across 15 active clinic/center providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1262500 | |
| 01 (ID) | 10136831 | BLUE SHIELD |
| 01 (ID) | J5842 | BLUE CROSS |
Part of a multi-provider practice. 20 other active providers share this practice address in NPPES.
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