NPI age
12 years
Enumerated 2013-06-19
Across 504 active internal medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1386083764 | |
| 01 (ID) | M-13287 | MEDICAL LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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