NPI age
19 years
Enumerated 2006-07-05
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010029526 | REGENCE BLUE SHIELD HS65 |
| 01 (WA) | 171111 | LABOR AND INDUSTRIES |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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