NPI age
19 years
Enumerated 2007-03-08
Across 305 active specialist providers in Idaho.
2 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 290545 | BSID |
| 01 (HI) | CK7354 | RR MEDICARE |
| 01 (ID) | 8K255 | BCID |
| 05 (ID) | 804259800 |
Multi-provider organization. 2 individual providers on file at this primary address.
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