NPI age
20 years
Enumerated 2005-12-30
Across 387 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | PASQ2 | BLUE CROSS |
| 05 (ID) | 806420100 |
Part of a multi-provider practice. 240 other active providers share this practice address in NPPES.
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