NPI age
19 years
Enumerated 2007-02-02
Across 67 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 001852402 | |
| 01 (ID) | 000010002158 | BLUE SHIELD |
| 01 (ID) | 1134802 | CIGNA MEDICARE |
| 01 (ID) | 45948 | BLUE CROSS |
| 01 (ID) | P00067562 | RR MEDICARE |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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