NPI age
19 years
Enumerated 2006-10-12
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010159329 | BS CMMC |
| 01 (ID) | B5630 | BC CMMC |
| 01 (ID) | 76693 | BC PLMC |
| 01 (ID) | 000010157502 | BS PLMC |
| 05 (ID) | 807509600 |
Part of a multi-provider practice. 16 other active providers share this practice address in NPPES.
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