NPI age
20 years
Enumerated 2006-04-17
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 80736340004 | |
| 01 (AR) | 20849 | MD LICENSE |
| 01 (CA) | G69647 | MD LICENSE |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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