NPI age
20 years
Enumerated 2006-02-09
Across 504 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 808524600 | |
| 01 (ID) | P00809329 | MCRR |
Part of a multi-provider practice. 58 other active providers share this practice address in NPPES.
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