NPI age
20 years
Enumerated 2006-05-20
Across 504 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | P00191484 | RAILROAD MEDICARE |
| 05 (ID) | 805294800 | |
| 01 (ID) | 201188708 | CHAMPUS |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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