NPI age
18 years
Enumerated 2008-03-06
Across 3 active pediatrics providers in Idaho.
6 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807573500 | |
| 01 (ID) | 2618808087 | CIGNA |
| 01 (ID) | 000010158422 | REGENCE BLUESHIELD |
| 01 (ID) | B6254 | BCBS |
| 01 (WY) | 123868000 | WYOMING MEDICAID |
Multi-provider organization. 6 individual providers on file at this primary address.
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