NPI age
19 years
Enumerated 2006-06-28
Across 38 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (WA) | 1116839 | |
| 01 (ID) | 51383 | BC ID |
| 01 (ID) | 020053777 | RR MEDICARE |
| 05 (ID) | 806435600 |
Part of a multi-provider practice. 12 other active providers share this practice address in NPPES.
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