NPI age
18 years
Enumerated 2007-06-01
Across 5 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1326240425 | |
| 05 (IA) | 1326240425 | |
| 05 (NE) | 1326240425 | |
| 05 (SD) | 1326240425 |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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