NPI age
11 years
Enumerated 2014-06-23
Across 85 active psychiatry & neurology providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (MO) | 2014014255 | MISSOURI TEMPORARY LICENSE NUMBER |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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