NPI age
17 years
Enumerated 2009-01-22
Across 1263 active physician assistant providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (CO) | P00719386 | RAILROAD MEDICARE |
| 01 | 1750529269 | NPI |
| 05 (CO) | 19979550 | |
| 05 (ID) | 1366637068 |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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