NPI age
17 years
Enumerated 2008-09-23
Across 1263 active physician assistant providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | PA-768 | IDAHO BOARD OF MEDICINE |
| 05 (ID) | 1629228978 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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