NPI age
20 years
Enumerated 2006-03-01
Across 260 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1528035276 | NPI |
| 01 (ID) | 020051465 | RAILROAD MEDICARE |
| 01 (ID) | 204186533 | TAX ID |
| 01 (ID) | 57851 | BLUE CROSS |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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