NPI age
19 years
Enumerated 2006-09-02
Across 22 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (SC) | G38703 | |
| 05 (GA) | 749438E | |
| 01 (GA) | 83BBCBD | MEDICARE ID |
Part of a multi-provider practice. 223 other active providers share this practice address in NPPES.
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