NPI age
19 years
Enumerated 2006-08-28
Across 336 active emergency medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | B5612 | BLUE CROSS |
| 01 (ID) | 1639287865 | NPI |
| 01 (ID) | 204186533 | TAX I.D. NUMBER |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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