NPI age
20 years
Enumerated 2005-06-21
Across 305 active specialist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | DW094 | BLUE CROSS OF IDAHO |
| 05 (ID) | 002581400 | |
| 01 (ID) | 000010135113 | BLUE SHIELD OF IDAHO |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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