NPI age
19 years
Enumerated 2007-02-02
Across 305 active specialist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010157357 | BLUE SHIELD |
| 01 (ID) | 76944 | BLUE CROSS |
| 05 (ID) | 807530600 |
Solo or small practice. No other active providers share this practice address in NPPES.
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