NPI age
19 years
Enumerated 2006-08-10
Across 9 active orthopaedic surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002754200 | |
| 01 (ID) | 820476391 | TAX PAYER IDENTIFICATION# |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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