NPI age
20 years
Enumerated 2005-06-28
Across 56 active otolaryngology providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (MT) | 0083113 | MEDICAID |
| 01 (WA) | 8409260 | MEDICAID |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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