NPI age
19 years
Enumerated 2006-07-03
Across 228 active obstetrics & gynecology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (OR) | 275405 | |
| 01 (OR) | 9305053253018 | EMPLOYER ID |
| 01 (OR) | P00163218 | PACIFIC SOURCE |
| 01 (OR) | 079178000 | BLUE CROSS |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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