NPI age
19 years
Enumerated 2006-06-08
Across 111 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002769900 | |
| 01 (ID) | RR MEDICARE | 100016984 |
Part of a multi-provider practice. 17 other active providers share this practice address in NPPES.
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