NPI age
19 years
Enumerated 2006-06-03
Across 248 active radiology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 804254800 | |
| 01 | M5021 | ID LICENSE NUMBER |
Part of a multi-provider practice. 144 other active providers share this practice address in NPPES.
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