NPI age
20 years
Enumerated 2006-05-15
Across 15 active pediatrics providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 0027267 | |
| 01 (OR) | 121173 | OMAP (OREGON MEDICAID) |
| 01 (ID) | 12799 | BLUE CROSS |
| 01 (ID) | 00010017912 | BLUE SHIELD |
Part of a multi-provider practice. 186 other active providers share this practice address in NPPES.
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