NPI age
19 years
Enumerated 2006-08-30
Across 1691 active family medicine providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 806053800 | |
| 01 (ID) | S5817 | BLUE CROSS |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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