NPI age
19 years
Enumerated 2006-10-06
Across 1691 active family medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 808440300 | |
| 01 (ID) | 000010174773 | REGENCE BLUE SHIELD OF IDAHO |
| 05 (ID) | 808440302 | |
| 01 (OR) | MD125789 | OREGON LICENSE NUMBER |
| 05 (ID) | 808440301 | |
| 01 (ID) | M10681 | IDAHO LICENSE NUMBER |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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