NPI age
19 years
Enumerated 2006-11-08
Across 22 active internal medicine providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (OR) | 500815912 | |
| 05 (SC) | 168286 |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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