NPI age
20 years
Enumerated 2006-04-03
Across 67 active internal medicine providers in Idaho.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (PA) | 0008511390003 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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