NPI age
19 years
Enumerated 2007-02-14
Across 68 active podiatrist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 1629111497 | NPI |
| 01 (ID) | P140-7 | BLUE CROSS |
| 05 (ID) | 001310400 | |
| 01 (ID) | 000010015609 | BLUE SHIELD |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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