NPI age
19 years
Enumerated 2006-10-17
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | P00654619 | MCRR |
| 05 (ID) | 808037200 |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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