NPI age
20 years
Enumerated 2005-10-19
Across 1263 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 1667206 | MEDICARE |
| 05 (ID) | 807287300 |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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