NPI age
19 years
Enumerated 2006-09-22
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (MT) | 0082620 | |
| 01 (MT) | 000097605 | BCBS |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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