NPI age
19 years
Enumerated 2007-03-29
Across 252 active pediatrics providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 | P00652182 | RAILROAD MEDICARE |
| 05 (ID) | 8080229 |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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