NPI age
14 years
Enumerated 2012-05-04
Across 260 active surgery providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | M-17496 | |
| 05 (IN) | 300053478 |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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