NPI age
18 years
Enumerated 2007-11-07
Across 69 active neurological surgery providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 21120 | BLUE CROSS OF IDAHO |
| 01 (ID) | 100001266946 | REGENCE BLUESHIELD OF IDAHO |
| 05 (ID) | 1578743522 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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