NPI age
20 years
Enumerated 2005-09-23
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010016730 | BLUE SHIELD |
| 01 (ID) | NP414 | BLUE CROSS/TRUE BLUE |
Part of a multi-provider practice. 23 other active providers share this practice address in NPPES.
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