NPI age
20 years
Enumerated 2006-03-08
Across 1263 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (TN) | 3663908 | |
| 01 (TN) | 4140845 | BC/BS |
| 01 (TN) | 4141412 | BC/BS |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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