NPI age
19 years
Enumerated 2006-08-09
Across 252 active pediatrics providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010028237 | REGENCE BLUE SHIELD |
| 05 (ID) | 805743100 | |
| 01 (ID) | J3961 | BLUE CROSS OF IDAHO |
| 05 (WA) | 8267098 |
Part of a multi-provider practice. 58 other active providers share this practice address in NPPES.
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