NPI age
20 years
Enumerated 2006-04-13
Across 260 active surgery providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 003570900 | |
| 01 (ID) | 000010004422 | REGENCE BLUE SHIELD |
| 01 (ID) | 59725 | BLUE CROSS OF IDAHO |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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