NPI age
19 years
Enumerated 2006-10-02
Across 1691 active family medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (OR) | 079587 | |
| 01 (OR) | 4002804-02 | REGENCE PC 65 |
| 01 (OR) | 0237420-02 | REGENCE BLUE CROSS OF OR |
| 01 (OR) | H2549-02 | PACIFIC SOURCE |
| 01 (OR) | 122912 | DEPT OF LABOR WORK COMP |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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