NPI age
20 years
Enumerated 2006-05-09
Across 248 active radiology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (OR) | 004837002 | BLUE CROSS |
| 05 (OR) | 058052 | |
| 01 (ID) | 003639600 | MEDICAID |
Part of a multi-provider practice. 378 other active providers share this practice address in NPPES.
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