NPI age
19 years
Enumerated 2006-12-01
Across 387 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | PAD92 | BLUE CROSS PIN |
| 01 (ID) | 000010158675 | REGENCE PIN |
Solo or small practice. No other active providers share this practice address in NPPES.
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