NPI age
19 years
Enumerated 2006-12-26
Across 3 active pediatrics providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010158422 | REGENCE BLUESHIELD |
| 01 (ID) | B6254 | BCBS |
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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