NPI age
15 years
Enumerated 2011-04-06
Across 67 active podiatrist providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 20005139 | MEDICARE PTAN |
| 01 (ID) | 820382500 | TAX ID |
| 01 (ID) | 1316236797 | NPI |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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