NPI age
19 years
Enumerated 2006-06-19
Across 504 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010004088 | REGENCE BLUE SHIELD |
| 01 (ID) | 3620-2 | BLUE CROSS |
| 01 (ID) | MD1942 | IDAHO STATE NARC. # |
Part of a multi-provider practice. 33 other active providers share this practice address in NPPES.
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