NPI age
19 years
Enumerated 2007-02-01
Across 67 active internal medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002745702 | |
| 01 (ID) | P00060779 | RR MEDICARE |
| 01 (ID) | 1129895 | CIGNA MEDICARE |
| 01 (ID) | 000010003601 | BLUE SHIELD |
| 01 (ID) | 45831 | BLUE CROSS |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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